Provider Demographics
NPI:1053197319
Name:MAISONET, ADALIS
Entity type:Individual
Prefix:
First Name:ADALIS
Middle Name:
Last Name:MAISONET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26B SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-1526
Mailing Address - Country:US
Mailing Address - Phone:617-905-1842
Mailing Address - Fax:
Practice Address - Street 1:26B SUMMER ST
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-1526
Practice Address - Country:US
Practice Address - Phone:617-905-1842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist