Provider Demographics
NPI:1588538789
Name:MALVO, REGINALD
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:
Last Name:MALVO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3519 E WALNUT ST # 158
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-4717
Mailing Address - Country:US
Mailing Address - Phone:316-210-1082
Mailing Address - Fax:
Practice Address - Street 1:20550 TOWNSEN BLVD UNIT 106-2
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4445
Practice Address - Country:US
Practice Address - Phone:316-210-1082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies