Healthcare Provider Details

I. General information

NPI: 1154860476
Provider Name (Legal Business Name): ZULEYKA ROSA MALAVE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 CALLE 30 PARCELAS FALU
SAN JUAN PR
00924
US

IV. Provider business mailing address

268 CALLE 30 PARCELAS FALU
SAN JUAN PR
00924-3121
US

V. Phone/Fax

Practice location:
  • Phone: 787-405-0919
  • Fax: 787-723-6247
Mailing address:
  • Phone: 787-405-0919
  • Fax: 787-723-6247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number70114
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: