Provider Demographics
NPI:1154876100
Name:MALAVE, CAROLINA DEL VALLE (SA-C)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:DEL VALLE
Last Name:MALAVE
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19748 E COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2523
Mailing Address - Country:US
Mailing Address - Phone:305-846-0806
Mailing Address - Fax:
Practice Address - Street 1:19748 EAST COUTRY CLUB DRIVE
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2523
Practice Address - Country:US
Practice Address - Phone:305-846-0806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15-354246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO15-354OtherSA-C