Healthcare Provider Details

I. General information

NPI: 1497579577
Provider Name (Legal Business Name): JOHN MALINOWSKI PARAMEDIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO DR SE
ALBUQUERQUE NM
87108-5153
US

IV. Provider business mailing address

1501 SAN PEDRO DR SE
ALBUQUERQUE NM
87108-5153
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax:
Mailing address:
  • Phone: 505-265-1711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number17000617
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number751370
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number834407504770
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: