Provider Demographics
NPI:1447940861
Name:MALDONADO, CIARA GIZELLE (DC)
Entity type:Individual
Prefix:
First Name:CIARA
Middle Name:GIZELLE
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 G ST UNIT F1
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4559
Mailing Address - Country:US
Mailing Address - Phone:619-430-6990
Mailing Address - Fax:
Practice Address - Street 1:350 G ST UNIT F1
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4559
Practice Address - Country:US
Practice Address - Phone:619-430-6990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36633111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor