| Loretto Maldonado, Phd Pa | |
|
398 Camino Gardens Blvd Suite 207 Boca Raton FL 33432-5827 | |
| (561) 367-9997 | |
| (561) 391-3574 |
| Full Name | Loretto Maldonado, Phd Pa |
|---|---|
| Speciality | Psychologist |
| Location | 398 Camino Gardens Blvd, Boca Raton, Florida |
| Authorized Official Name and Position | Loretto Maldonado (PRESIDENT) |
| Authorized Official Contact | 5613679997 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Loretto Maldonado, Phd Pa 398 Camino Gardens Blvd Suite 207 Boca Raton FL 33432-5827 Ph: () - | Loretto Maldonado, Phd Pa 398 Camino Gardens Blvd Suite 207 Boca Raton FL 33432-5827 Ph: (561) 367-9997 |
| NPI Number | 1053605253 |
|---|---|
| Provider Enumeration Date | 06/06/2011 |
| Last Update Date | 06/06/2011 |
| Medicare PECOS PAC ID | 2062675341 |
|---|---|
| Medicare Enrollment ID | O20120524000161 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053605253 | NPI | - | NPPES |
| 73205 | Other | FL | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PY0003787 (Florida) | Primary |
| Provider Name | Loretto J Maldonado |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1215031406 PECOS PAC ID: 5597928887 Enrollment ID: I20120524000228 |
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