Provider Demographics
NPI:1801610019
Name:MALAVE-TZIRIMIS, SEBASTIAN NICOLAS (PA-C)
Entity type:Individual
Prefix:
First Name:SEBASTIAN
Middle Name:NICOLAS
Last Name:MALAVE-TZIRIMIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-1131 AHOKELE ST
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-5565
Mailing Address - Country:US
Mailing Address - Phone:808-343-2158
Mailing Address - Fax:
Practice Address - Street 1:33 LONO AVE STE 250
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-1634
Practice Address - Country:US
Practice Address - Phone:808-500-3439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical