Individual provider Active NPI

Anna Rose Maldonado, M.D

  • Pediatrics Physician
  • San Antonio, TX
National Provider Identifier
1053438879
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
41108 Issued in WA
Practice address
1613 Kentucky Ave
San Antonio, TX 78201-5822
Phone
(210) 573-4031
NPI assigned
Mar 25, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 41108 WA Primary

Addresses

Primary practice location

1613 Kentucky Ave
San Antonio, TX 78201-5822

Mailing address

1613 Kentucky Ave
San Antonio, TX 78201-5822
Phone (210) 573-4031

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
41108WAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Marillac Community Health Centers Past Accepting new patients
Marillac Community Health Centers PastSince Nov 1, 2023 Accepting new patients
Marillac Community Health Centers PastSince Oct 4, 2020 Accepting new patients
Marillac Community Health Centers Past Accepting new patients
Marillac Community Health Centers Past Accepting new patients
Marillac Community Health Centers Past Accepting new patients

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053438879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1613 KENTUCKY AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782015822",
            "telephone_number": "210-573-4031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1613 KENTUCKY AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782015822",
            "telephone_number": "210-573-4031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALDONADO",
        "first_name": "ANNA",
        "middle_name": "ROSE",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "41108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.