Provider Demographics
NPI:1124089230
Name:MALACARA, JAN (PA-C)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:MALACARA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36075 S RINCON RD
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390
Mailing Address - Country:US
Mailing Address - Phone:928-684-9594
Mailing Address - Fax:480-607-5119
Practice Address - Street 1:36075 S RINCON RD
Practice Address - Street 2:ROSEWOOD RANCH
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390
Practice Address - Country:US
Practice Address - Phone:928-684-9594
Practice Address - Fax:480-607-5119
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
AZ3226363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX453835Medicare ID - Type Unspecified
TX00L82SMedicare ID - Type Unspecified