Provider Demographics
NPI:1396596532
Name:MALVAR, JOSE ANTONIO P
Entity type:Individual
Prefix:
First Name:JOSE ANTONIO
Middle Name:P
Last Name:MALVAR
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 1:7920 JASPENCE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-5179
Mailing Address - Country:US
Mailing Address - Phone:702-727-7288
Mailing Address - Fax:
Practice Address - Street 1:5926 AZZURA PALMS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-6968
Practice Address - Country:US
Practice Address - Phone:702-927-7134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant