MEDICARE: DR. MARY JOAHN RODRIGUEZ-MALAVE MD, MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	22234	PR

General Provider Information

NPI Number	:	1114418563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY JOAHN RODRIGUEZ-MALAVE MD, MPH

Provider Business Mailing Address
First Line	:	29 CALLE BASILIO CATALA
Second Line	:	COND. PRADOS DEL MONTE, APT. 608
City	:	GUAYNABO
State	:	PR
Zip	:	00971-0000
Country	:	US
Telephone Number	:	787-313-4303
Fax Number	:	787-873-4303

Provider Business Practice Location Address
First Line	:	VA CARIBBEAN HEALTHCARE SYSTEM
Second Line	:	10 CASIA ST
City	:	SAN JUAN
State	:	PR
Zip	:	00921-0000
Country	:	US
Telephone Number	:	787-641-7582
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2018
Last Update Date	:	10/08/2021

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