Provider Demographics
NPI:1396570420
Name:GONZALEZ MALAVE, DALIA IVELIZ (MD)
Entity type:Individual
Prefix:
First Name:DALIA
Middle Name:IVELIZ
Last Name:GONZALEZ MALAVE
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:PO BOX 60401
Mailing Address - Street 2:PMB 126
Mailing Address - City:SAN ANTONIO
Mailing Address - State:PR
Mailing Address - Zip Code:00690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 60401
Practice Address - Street 2:PMB 126
Practice Address - City:SAN ANTONIO
Practice Address - State:PR
Practice Address - Zip Code:00690
Practice Address - Country:US
Practice Address - Phone:787-356-7958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR24093208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice