Provider Demographics
NPI:1336500016
Name:MALCOLM, AMY (CCP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MALCOLM
Suffix:
Gender:F
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A10 CALLE PALMAR REAL
Mailing Address - Street 2:URB PALMAR NORTE
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979
Mailing Address - Country:US
Mailing Address - Phone:787-981-5211
Mailing Address - Fax:
Practice Address - Street 1:A10 CALLE PALMAR REAL
Practice Address - Street 2:URB PALMAR NORTE
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979
Practice Address - Country:US
Practice Address - Phone:787-981-5211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist