Healthcare Provider Details

I. General information

NPI: 1184990251
Provider Name (Legal Business Name): CLINICA DEL DR MALAVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 03/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 MARGINAL LOCAL 203 URB LA RAMBLA
PONCE PR
00730
US

IV. Provider business mailing address

PO BOX 801504
COTO LAUREL PR
00780-1504
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3583
License Number StatePR

VIII. Authorized Official

Name: DR. JOSE D MALAVE ORENGO
Title or Position: PRESIDENT
Credential: PH.D
Phone: 787-385-2162