Provider Demographics
NPI:1104017029
Name:MALAVE, DAISY (MD)
Entity Type:Individual
Prefix:DR
First Name:DAISY
Middle Name:
Last Name:MALAVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52120
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-2120
Mailing Address - Country:US
Mailing Address - Phone:787-459-2347
Mailing Address - Fax:
Practice Address - Street 1:2043 PASEO AZALEA
Practice Address - Street 2:2DA EXT LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4256
Practice Address - Country:US
Practice Address - Phone:787-459-2347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12665208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice