Individual
MR. JAIME RICARDO MALDONADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
204 E LOGAN AVE, GALLUP, NM 87301-6134
(505) 728-5060
Mailing address
1000 E AZTEC AVE, GALLUP, NM 87301-5509
(505) 721-1865
(500) 721-1899
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A-305
NM
Other
Enumeration date
10/31/2017
Last updated
10/31/2017
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