Provider Demographics
NPI:1679912117
Name:MALDONADO PENA, JEFFREY DE JESUS (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DE JESUS
Last Name:MALDONADO PENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5040 NW 7TH ST
Mailing Address - Street 2:STE 635
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3796
Mailing Address - Country:US
Mailing Address - Phone:305-644-2212
Mailing Address - Fax:
Practice Address - Street 1:5040 NW 7TH ST STE 635
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3796
Practice Address - Country:US
Practice Address - Phone:305-644-2212
Practice Address - Fax:786-475-7787
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR29336-R207R00000X
NC2019-02370207RN0300X
FLME146935207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine