Provider Demographics
NPI:1346982303
Name:MALVENTANO OROZCO, REBECCA SOFIA (DMD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SOFIA
Last Name:MALVENTANO OROZCO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:MALVENTANO OROZCO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1770 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-4787
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1770 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-4787
Practice Address - Country:US
Practice Address - Phone:212-241-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program