Provider Demographics
NPI:1881977809
Name:MALFAVON, MICHAEL PAUL
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PAUL
Last Name:MALFAVON
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 1:1615 FRENCH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-2475
Mailing Address - Country:US
Mailing Address - Phone:714-824-8141
Mailing Address - Fax:
Practice Address - Street 1:1615 FRENCH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2475
Practice Address - Country:US
Practice Address - Phone:714-824-8141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health