Provider Demographics
NPI:1528007788
Name:MIRANDA MALAVE, RAFAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
Last Name:MIRANDA MALAVE
Suffix:
Gender:M
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:B5 CALLE CAMARERO
Mailing Address - Street 2:URB. PARQUE ECUESTRE
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-8510
Mailing Address - Country:US
Mailing Address - Phone:787-762-5316
Mailing Address - Fax:787-762-5316
Practice Address - Street 1:B5 CALLE CAMARERO
Practice Address - Street 2:URB. PARQUE ECUESTRE
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-8510
Practice Address - Country:US
Practice Address - Phone:787-762-5316
Practice Address - Fax:787-762-5316
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7434207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0028558Medicare ID - Type Unspecified
PRE43408Medicare UPIN