Active NPI
Eddie Modesto Maldonado, BS.,CMP
- Other Technician
- Redondo Beach, CA
National Provider Identifier
1295053544
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- License
- 986
- Practice address
- 503 N PCH Hwy
Redondo Beach, CA 90277-2104 - Phone
- (310) 376-5253
- NPI assigned
- May 12, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | 986 | CA | Primary |
Addresses
Primary practice location
503 N PCH Hwy
Redondo Beach, CA 90277-2104
Mailing address
4702 W. 132ND St.
Hawthorne, CA 90250
Phone (310) 978-1658
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)
- Not enrolled
- Credentials
- Bachelor of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1273622400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1274400000000",
"number": "1295053544",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4702 W. 132ND ST.",
"city": "HAWTHORNE",
"state": "CA",
"postal_code": "90250",
"telephone_number": "310-978-1658"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "503 N PCH HWY",
"city": "REDONDO BEACH",
"state": "CA",
"postal_code": "902772104",
"telephone_number": "310-376-5253"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALDONADO",
"first_name": "EDDIE",
"middle_name": "MODESTO",
"name_prefix": "Mr.",
"credential": "BS.,CMP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-05-12",
"last_updated": "2010-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "CA",
"license": "986",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redondo Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.