Provider Demographics
NPI:1265089981
Name:CARDONA MALAVE, VALERIA NICOLE
Entity type:Individual
Prefix:
First Name:VALERIA
Middle Name:NICOLE
Last Name:CARDONA 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 1:800 S PARK RD # 2-11
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8716
Mailing Address - Country:US
Mailing Address - Phone:787-309-4445
Mailing Address - Fax:
Practice Address - Street 1:2366 WESTON RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3260
Practice Address - Country:US
Practice Address - Phone:631-632-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2022-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN274991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program