Individual
DEBRA BENNETTE MALDONADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
124 CARMEN LN STE A, SANTA MARIA, CA 93458-7768
(805) 348-1850
Mailing address
124 CARMEN LN STE A, SANTA MARIA, CA 93458-7768
(805) 348-1850
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
42501
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1316192149
TELECARE SANTA MARIA FSP
—
Enumeration date
03/13/2023
Last updated
09/05/2023
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