Provider Demographics
NPI:1962728063
Name:MALININ, THEODORE
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:
Last Name:MALININ
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 1:1600 NW 10TH AVE
Mailing Address - Street 2:ROOM 8084
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1015
Mailing Address - Country:US
Mailing Address - Phone:305-243-5673
Mailing Address - Fax:305-243-1398
Practice Address - Street 1:1600 NW 10TH AVE
Practice Address - Street 2:ROOM 8084
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1015
Practice Address - Country:US
Practice Address - Phone:305-243-5673
Practice Address - Fax:305-243-1398
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME24402174400000X
FL193400000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist