Active NPI
Miguel Jovany Maldonado, LMP
- Specialist
- Kent, WA
National Provider Identifier
1487044400
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MA60412291
- Practice address
- 9003 Canyon Dr
Kent, WA 98030-4779 - Phone
- (253) 876-4900
- Fax
- (888) 357-7244
- NPI assigned
- Jan 28, 2015
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Specialist | 174400000X | MA60412291 | WA | Primary |
Addresses
Primary practice location
9003 Canyon Dr
Kent, WA 98030-4779
Mailing address
9003 Canyon Dr
Kent, WA 98030-4779
Phone (253) 876-4900
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA60412291 | WA | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Massage Injury Network LLC | Specialist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Specialist
- Kent, WA
- NPI 1902279458
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1422403200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1422403200000",
"number": "1487044400",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9003 CANYON DR",
"city": "KENT",
"state": "WA",
"postal_code": "980304779",
"telephone_number": "253-876-4900",
"fax_number": "888-357-7244"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9003 CANYON DR",
"city": "KENT",
"state": "WA",
"postal_code": "980304779",
"telephone_number": "253-876-4900",
"fax_number": "888-357-7244"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALDONADO",
"first_name": "MIGUEL",
"middle_name": "JOVANY",
"credential": "LMP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-01-28",
"last_updated": "2015-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "WA",
"license": "MA60412291",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kent, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.