Healthcare Provider Details

I. General information

NPI: 1205039047
Provider Name (Legal Business Name): LIZA MARIEL PAULO MALAVE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 AVE PEDRO ALBIZU CAMPOS REPARTO LOPEZ
AGUADILLA PR
00603-5714
US

IV. Provider business mailing address

GALLERY PLAZA 103 AVE JOSE DE DIEGO APT 2107
SAN JUAN PR
00911-3523
US

V. Phone/Fax

Practice location:
  • Phone: 787-671-6167
  • Fax: 787-765-5147
Mailing address:
  • Phone: 787-891-0027
  • Fax: 787-997-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number16861
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: