Individual
MR. EDDIE MODESTO MALDONADO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BS.,CMP
Contact information
Practice address
503 N PCH HWY, REDONDO BEACH, CA 90277-2104
(310) 376-5253
Mailing address
4702 W. 132ND ST., HAWTHORNE, CA 90250
(310) 978-1658
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
986
CA
Other
Enumeration date
05/12/2010
Last updated
05/21/2010
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