Healthcare Provider Details

I. General information

NPI: 1336353960
Provider Name (Legal Business Name): JOSE DOMINGO MALAVE PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

# 471 FERROCARRIL STREET , STA. MARIA SHOPPING CENTER 234
PONCE PR
00731
US

IV. Provider business mailing address

VALLE ALTO CALLE LLANURAS 1792
PONCE PR
00731
US

V. Phone/Fax

Practice location:
  • Phone: 787-651-0030
  • Fax:
Mailing address:
  • Phone: 787-385-2162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number204859
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3583
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: