Provider Demographics
NPI:1164262036
Name:MALAVE, BELKIS DE LOS SANTOS
Entity type:Individual
Prefix:MRS
First Name:BELKIS
Middle Name:DE LOS SANTOS
Last Name:MALAVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W EDWATER ST
Mailing Address - Street 2:112 W EDWATER ST
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012
Mailing Address - Country:US
Mailing Address - Phone:539-900-9733
Mailing Address - Fax:
Practice Address - Street 1:112 W EDWATER ST BROKEN ARROW
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012
Practice Address - Country:US
Practice Address - Phone:539-900-9733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist