MEDICARE: DALIA IVELIZ GONZALEZ MALAVE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	24093	PR

General Provider Information

NPI Number	:	1396570420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALIA IVELIZ GONZALEZ MALAVE MD

Provider Business Mailing Address
First Line	:	PO BOX 60401 PMB 126
Second Line	:
City	:	SAN ANTONIO
State	:	PR
Zip	:	00690-9003
Country	:	US
Telephone Number	:	787-896-6975
Fax Number	:	787-896-6975

Provider Business Practice Location Address
First Line	:	PO BOX 60401
Second Line	:	PMB 126
City	:	SAN ANTONIO
State	:	PR
Zip	:	00690
Country	:	US
Telephone Number	:	787-356-7958
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2024
Last Update Date	:	12/30/2025

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