MEDICARE: DR. AIDA A. MALONZO 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	207V00000X	Obstetrics & Gynecology Physician	037964	FL

General Provider Information

NPI Number	:	1871614057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AIDA A. MALONZO MD

Provider Business Mailing Address
First Line	:	1512 PALM AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-2916
Country	:	US
Telephone Number	:	904-399-8383
Fax Number	:	904-399-8383

Provider Business Practice Location Address
First Line	:	1512 PALM AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-2916
Country	:	US
Telephone Number	:	904-399-8383
Fax Number	:	904-399-8383

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/08/2007

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