Healthcare Provider Details

I. General information

NPI: 1619601465
Provider Name (Legal Business Name): JEAN-PHILIPPE MALATY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 ARTIST RD # 58
SANTA FE NM
87501-2079
US

IV. Provider business mailing address

320 ARTIST RD # 58
SANTA FE NM
87501-2079
US

V. Phone/Fax

Practice location:
  • Phone: 970-379-9838
  • Fax:
Mailing address:
  • Phone: 970-379-9838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: