Andres Maldonado

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95021143 Issued in CA

Practice address

2026 N Imperial Ave Ste C
El Centro, CA 92243-1607

Phone

(760) 592-4351

NPI assigned

Jun 18, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tyson Medical IncGroup PAC ID 3072870112, 21 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Tyson Medical Inc

  • Family Medicine Physician
  • Calexico, CA
  • NPI 1467241570
  Medicare reassignment Care Compare group NPD
• Tyson Medical Inc

  dba All Valley Urgent Care

  • Urgent Care Clinic/Center
  • El Centro, CA
  • NPI 1376053843
  NPD
• Imperial Clinical & Pathology Lab LLC

  • Clinical Medical Laboratory
  • El Centro, CA
  • NPI 1598568685
  NPD (past)

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

{
    "created_epoch": "1403049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656633600000",
    "number": "1699189522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2026 N IMPERIAL AVE STE C",
            "city": "EL CENTRO",
            "state": "CA",
            "postal_code": "922431607",
            "telephone_number": "760-592-4351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2026 N IMPERIAL AVE STE C",
            "city": "EL CENTRO",
            "state": "CA",
            "postal_code": "922431607",
            "telephone_number": "760-592-4351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALDONADO",
        "first_name": "ANDRES",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-18",
        "last_updated": "2022-07-01",
        "certification_date": "2022-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "207502",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95021143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Omar Magana
• Melanie Magana
• Mahan Anesthesia Cali LLC
• Vijaykanth Mahendrakar, M.D.
• Linda L. Mak, M.D.
• Camil Mayor Malong
• George J Maloof Jr., MD
• Silvestre Isaac Mancera
• Nayeli Victoria Mancillas
• Andy Mange

• Family Nurse Practitioner in El Centro, CA
• Providers in El Centro, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.