Individual
IVAN MALDONADO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6320 ARLINGTON RD, JACKSONVILLE, FL 32211-5430
(904) 743-9069
(904) 743-3584
Mailing address
6320 ARLINGTON RD, JACKSONVILLE, FL 32211-5430
(904) 743-9069
(904) 743-3584
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
AL8958
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
141157800
—
FL
Enumeration date
06/03/2014
Last updated
06/03/2014
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