Provider Demographics
NPI:1154531663
Name:RIVERA-MALAVE, LISVETTE M (DMD)
Entity type:Individual
Prefix:DR
First Name:LISVETTE
Middle Name:M
Last Name:RIVERA-MALAVE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20322 HUEBNER RD
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258
Mailing Address - Country:US
Mailing Address - Phone:210-491-4141
Mailing Address - Fax:210-494-4025
Practice Address - Street 1:20322 HUEBNER RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258
Practice Address - Country:US
Practice Address - Phone:210-491-4141
Practice Address - Fax:210-494-4025
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX192881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice