Provider Demographics
NPI:1043068240
Name:MALTHEUS, JEAN RENOLD (SA-C)
Entity type:Individual
Prefix:
First Name:JEAN RENOLD
Middle Name:
Last Name:MALTHEUS
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3579 COLLINWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-4130
Mailing Address - Country:US
Mailing Address - Phone:561-396-8897
Mailing Address - Fax:
Practice Address - Street 1:3579 COLLINWOOD LN
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-4130
Practice Address - Country:US
Practice Address - Phone:561-396-8897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-11
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-254246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant