Healthcare Provider Details

I. General information

NPI: 1396282455
Provider Name (Legal Business Name): CARLA MALAVE PHL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2017
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR.14 KM 48.6 BO ASOMANTE
AIBONITO PR
00705
US

IV. Provider business mailing address

PO BOX 381
AIBONITO PR
00705-0381
US

V. Phone/Fax

Practice location:
  • Phone: 877-877-3583
  • Fax:
Mailing address:
  • Phone: 787-215-3256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4061
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: