Provider Demographics
NPI:1790048213
Name:MALABANAN, DIOSDADO
Entity Type:Individual
Prefix:
First Name:DIOSDADO
Middle Name:
Last Name:MALABANAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2634 CARROLL PL
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-3821
Mailing Address - Country:US
Mailing Address - Phone:907-929-1463
Mailing Address - Fax:
Practice Address - Street 1:2634 CARROLL PL
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3821
Practice Address - Country:US
Practice Address - Phone:907-929-1463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker