Provider Demographics
NPI:1477668754
Name:MALAVE, MARISOL (MD)
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:MALAVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PARQ DEL SOL APT 329
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-4304
Mailing Address - Country:US
Mailing Address - Phone:787-726-0210
Mailing Address - Fax:787-728-5136
Practice Address - Street 1:CALLE SAN JORGE #252 SAN JORGE MEDIICAL OFFICE
Practice Address - Street 2:SUITE 406
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912
Practice Address - Country:US
Practice Address - Phone:787-726-0210
Practice Address - Fax:787-728-5136
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13,673208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8-9351OtherSSS