Provider Demographics
NPI:1447208244
Name:MALAVE, WILLIE NELSON (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:NELSON
Last Name:MALAVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WILLIE
Other - Middle Name:N
Other - Last Name:MALAVE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:CARR 129 KM 21.8
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00669
Mailing Address - Country:UM
Mailing Address - Phone:787-897-5555
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 129 KM 21.8
Practice Address - Street 2:INT. 454 BO. CALLEJONES
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669-0819
Practice Address - Country:US
Practice Address - Phone:787-897-5555
Practice Address - Fax:787-897-2521
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9721208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics