Provider Demographics
NPI:1588950513
Name:MALLEK, JENNIFER DE TOLEDO (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DE TOLEDO
Last Name:MALLEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT. 42655
Mailing Address - Street 2:P.O. BOX 650823
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12911 W 40TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80401-2696
Practice Address - Country:US
Practice Address - Phone:303-425-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME123239207L00000X
FLTRN15938207L00000X
CO0056931207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014756100Medicaid
CO1588950513Medicaid
FLTRN15938OtherTRAINING LICENCE
FLTRN15938OtherTRAINING LICENCE