Provider Demographics
NPI:1578890059
Name:MALAVE, EDWIN II (DPT)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:MALAVE
Suffix:II
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14375 PIPELINE AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5642
Mailing Address - Country:US
Mailing Address - Phone:909-517-3884
Mailing Address - Fax:909-517-3646
Practice Address - Street 1:14375 PIPELINE AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5642
Practice Address - Country:US
Practice Address - Phone:909-517-3884
Practice Address - Fax:909-517-3646
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT36084225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist