Provider Demographics
NPI:1235972456
Name:MALFARO, ELIZABETH EILEEN (STUDENT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:EILEEN
Last Name:MALFARO
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 AVE ISLA VERDE APT 6D
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-6716
Mailing Address - Country:US
Mailing Address - Phone:610-451-0535
Mailing Address - Fax:
Practice Address - Street 1:3919 AVE ISLA VERDE APT 6D
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-6716
Practice Address - Country:US
Practice Address - Phone:610-451-0535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-15
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program