Provider Demographics
NPI:1346734787
Name:MALVAR, MARINELLIE BRACEROS
Entity Type:Individual
Prefix:
First Name:MARINELLIE
Middle Name:BRACEROS
Last Name:MALVAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1580 WAHANE ST
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-3107
Mailing Address - Country:US
Mailing Address - Phone:808-647-3689
Mailing Address - Fax:808-680-9135
Practice Address - Street 1:91-1580 WAHANE ST
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-3107
Practice Address - Country:US
Practice Address - Phone:808-647-3689
Practice Address - Fax:808-680-9135
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care