Individual
MARCO MALDONADO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1600 N MAIN AVE, LOVINGTON, NM 88260
(575) 396-6611
Mailing address
1600 N MAIN AVE, LOVINGTON, NM 88260-2830
(575) 396-6611
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD2018-0153
NM
207Q00000X
Family Medicine Physician
RS2015-0486
NM
Other
Enumeration date
07/06/2015
Last updated
07/11/2018
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