Provider Demographics
NPI:1740032812
Name:SANTIAGO MALAVE, AMAURY SAMUEL
Entity type:Individual
Prefix:
First Name:AMAURY
Middle Name:SAMUEL
Last Name:SANTIAGO MALAVE
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 1:4436 ARUBA BLVD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5251
Mailing Address - Country:US
Mailing Address - Phone:787-365-8676
Mailing Address - Fax:
Practice Address - Street 1:1225 CENTER DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3007
Practice Address - Country:US
Practice Address - Phone:352-273-6312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program