Provider Demographics
NPI:1205039047
Name:PAULO MALAVE, LIZA MARIEL (MD)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:MARIEL
Last Name:PAULO MALAVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:GALLERY PLAZA 103
Mailing Address - Street 2:AVE JOSE DE DIEGO APT 2107
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911
Mailing Address - Country:US
Mailing Address - Phone:787-891-0027
Mailing Address - Fax:787-997-2222
Practice Address - Street 1:APTO #5004
Practice Address - Street 2:JARDINES DEL PARQUE, ESCORIAL
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-671-6167
Practice Address - Fax:787-765-5147
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR16861207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR037808000Medicaid