Ivan Maldonado

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

AL8958 Issued in FL

Practice address

6320 Arlington Rd
Jacksonville, FL 32211-5430

Phone

(904) 743-9069

Fax

(904) 743-3584

NPI assigned

Jun 3, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Arlington Haven

  • Assisted Living Facility (Mental Illness)
  • Jacksonville, FL
  • NPI 1275941833

  Assisted Living, Mental Illness

  NPD (past) Authorized official

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

{
    "created_epoch": "1401753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401753600000",
    "number": "1952714404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6320 ARLINGTON RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322115430",
            "telephone_number": "904-743-9069",
            "fax_number": "904-743-3584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6320 ARLINGTON RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322115430",
            "telephone_number": "904-743-9069",
            "fax_number": "904-743-3584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALDONADO",
        "first_name": "IVAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-06-03",
        "last_updated": "2014-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "FL",
            "license": "AL8958",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "141157800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karen Marie Malcolm
• Emma Mae Malcom
• Sean Emmanuel Maldonado Ramirez, M.D.
• Christine Maldonado
• Isaac S Maldonado
• Javier Maldonado, DDS
• Roxana Maldonado
• Irene Elaine Malesic, MD
• Alina Zofia Maleski, MD
• Nitika Malhotra, M.D

• Assisted Living Facility (Mental Illness) in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Assisted Living Facility (Mental Illness) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2014; 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.