Individual
DAVID JAKE MALDONADO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
30 VERDE RIDGE ST APT C, LOS ALAMOS, NM 87544-3243
(505) 515-9816
Mailing address
30 VERDE RIDGE ST APT C, LOS ALAMOS, NM 87544-3243
(505) 515-9816
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
01/19/2015
Last updated
04/08/2016
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