Healthcare Provider Details

I. General information

NPI: 1447601182
Provider Name (Legal Business Name): ANTONY A MALO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 N 7TH ST
TERRE HAUTE IN
47804-2706
US

IV. Provider business mailing address

3703 LAMPPOST PL
PEARLAND TX
77584-9742
US

V. Phone/Fax

Practice location:
  • Phone: 713-357-8408
  • Fax:
Mailing address:
  • Phone: 713-357-8408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD185669
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28228395A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: