Organization
MALAVE SURGICAL GROUP,PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VICTOR BRIAN MALAVE MD (PRESIDENT)
(787) 600-4404
Entity
Organization
Contact information
Practice address
CARRETERA ESTATAL #3 KM 78.4, PARCELA 3 BO. RIO ABAJO, HUMACAO, PR 00791
(787) 600-4404
Mailing address
MANSIONES DE LOS ARTESANOS #14, LAS PIEDRAS, PR 00771
(787) 600-4404
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
15768
PR
207RI0008X
Hepatology Physician
15768
PR
208600000X
Surgery Physician
16315
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0026258
MEDICARE PTAN
PR
01
—
EC729A
MEDICARE PTAN
PR
Enumeration date
02/17/2014
Last updated
05/27/2014
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