Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DN17046 | FL |
NPI | 1013119502 |
---|---|
Provider Name | Mauricio A Malo |
First Address | Hollywood, FL 33026-4573 |
Second Address | Hollywood, FL 33026-4573 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 08/07/2007 |