Provider Demographics
NPI:1871582676
Name:MALDONADO TORRES, ENRIQUE A (MD)
Entity type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:A
Last Name:MALDONADO TORRES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:ESTANCIA DE YAUCO CALLE AMATISTA
Mailing Address - Street 2:D4
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698
Mailing Address - Country:US
Mailing Address - Phone:787-267-8791
Mailing Address - Fax:787-856-5642
Practice Address - Street 1:CENTRO COMMERCIAL BARINAS
Practice Address - Street 2:LOCAL #7 BO BARINAS
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698
Practice Address - Country:US
Practice Address - Phone:787-856-5642
Practice Address - Fax:787-856-5642
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2013-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR9793208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82643MAMedicaid
F28853Medicare UPIN
PR82643MAMedicaid