Provider Demographics
NPI:1447349014
Name:MALDONADO, DONALD EDWARD (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:EDWARD
Last Name:MALDONADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-6730
Mailing Address - Country:US
Mailing Address - Phone:714-635-0593
Mailing Address - Fax:714-635-0593
Practice Address - Street 1:1820 W LINCOLN AVENUE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-6730
Practice Address - Country:US
Practice Address - Phone:714-635-0593
Practice Address - Fax:714-774-4784
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46437208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G464370Medicaid
WA46437CMedicare ID - Type Unspecified
G16237Medicare UPIN