Provider Demographics
NPI:1477433266
Name:REIS MALAMAN, ANDRE
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:REIS MALAMAN
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 1:130 RICK FRANCIS ST
Mailing Address - Street 2:MSC 41030
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2841
Mailing Address - Country:US
Mailing Address - Phone:915-215-6000
Mailing Address - Fax:915-215-5367
Practice Address - Street 1:4815 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2705
Practice Address - Country:US
Practice Address - Phone:915-215-6000
Practice Address - Fax:915-215-5367
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-03
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX488352085R0202X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology