MEDICARE: MALVAR GROUP OF COMPANIES LLC

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	363LP2300X	Primary Care Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720850654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MALVAR GROUP OF COMPANIES LLC

Provider Business Mailing Address
First Line	:	5926 AZZURA PALMS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6968
Country	:	US
Telephone Number	:	702-927-7741
Fax Number	:

Provider Business Practice Location Address
First Line	:	5926 AZZURA PALMS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6968
Country	:	US
Telephone Number	:	702-927-7741
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	IRENE MALVAR
Credential	:
Telephone Number	:	702-927-7741

Provider Enumeration Date	:	10/24/2023
Last Update Date	:	10/24/2023

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