Provider Demographics
NPI:1598846339
Name:MALACAMAN, NELDA SANTOS (MD)
Entity Type:Individual
Prefix:DR
First Name:NELDA
Middle Name:SANTOS
Last Name:MALACAMAN
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 1:7766 WATERMARK LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4111
Mailing Address - Country:US
Mailing Address - Phone:904-824-5437
Mailing Address - Fax:904-824-7575
Practice Address - Street 1:493 PROSPERITY LAKE DR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-5045
Practice Address - Country:US
Practice Address - Phone:904-824-5437
Practice Address - Fax:904-824-7575
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96697208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics