Provider Demographics
NPI:1700928678
Name:MALLENS, CHRISTINE MARIE (OPTICIAN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:MARIE
Last Name:MALLENS
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:J4 CALLE 2
Mailing Address - Street 2:ALTURAS DEL RIO
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-8901
Mailing Address - Country:US
Mailing Address - Phone:787-402-3978
Mailing Address - Fax:787-870-7257
Practice Address - Street 1:34 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-2418
Practice Address - Country:US
Practice Address - Phone:787-870-2960
Practice Address - Fax:787-870-7257
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR755156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR57871OtherSSS