Provider Demographics
NPI:1922091644
Name:MALAVE-GOMEZ, ANGEL B, (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:B,
Last Name:MALAVE-GOMEZ
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:PO BOX 860
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0860
Mailing Address - Country:US
Mailing Address - Phone:787-891-5229
Mailing Address - Fax:
Practice Address - Street 1:2 CALLE PROGRESO
Practice Address - Street 2:SUITE 202
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5000
Practice Address - Country:US
Practice Address - Phone:787-891-5229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-28
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4194208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR25710Medicare ID - Type Unspecified