Healthcare Provider Details

I. General information

NPI: 1164846879
Provider Name (Legal Business Name): MALAVE SURGICAL GROUP,PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2014
Last Update Date: 05/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA ESTATAL #3 KM 78.4 PARCELA 3 BO. RIO ABAJO
HUMACAO PR
00791
US

IV. Provider business mailing address

MANSIONES DE LOS ARTESANOS #14
LAS PIEDRAS PR
00771
US

V. Phone/Fax

Practice location:
  • Phone: 787-600-4404
  • Fax:
Mailing address:
  • Phone: 787-600-4404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number15768
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number16315
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number15768
License Number StatePR

VIII. Authorized Official

Name: DR. VICTOR BRIAN MALAVE
Title or Position: PRESIDENT
Credential: MD
Phone: 787-600-4404