Provider Demographics
NPI:1164629408
Name:MALAVENDA, PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:MALAVENDA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4138 SW 16TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3867
Mailing Address - Country:US
Mailing Address - Phone:305-443-1103
Mailing Address - Fax:
Practice Address - Street 1:4138 SW 16TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33134-3867
Practice Address - Country:US
Practice Address - Phone:305-443-1103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5656111N00000X, 111NS0005X, 111NT0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Not Answered111NT0100XChiropractic ProvidersChiropractorThermography
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050238300Medicaid
FLT85297Medicare UPIN