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General NPI Number Information
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NPI Number | 1225847809
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Entity Type | Individual
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Provider Name | BRAULIO MALAVE LOPEZ PA
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Gender | Male
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 1302 AV JUAN PONCE DE LEON
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City | SAN JUAN
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State | PR
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Zip | 00907
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Country | US
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Telephone | 787-493-5088
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 262252
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City | SAN JUAN
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State | PR
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Zip | 00926-2654
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Country | US
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Telephone | 939-206-1416
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 001445-PA
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License Number State | PR
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