Provider Demographics
NPI:1336353960
Name:MALAVE, JOSE DOMINGO (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:DOMINGO
Last Name:MALAVE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:VALLE ALTO CALLE LLANURAS
Mailing Address - Street 2:1792
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00731
Mailing Address - Country:US
Mailing Address - Phone:787-385-2162
Mailing Address - Fax:
Practice Address - Street 1:# 471 FERROCARRIL STREET , STA. MARIA SHOPPING CENTER
Practice Address - Street 2:234
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-651-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR204859101YA0400X
PR3583103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)