1609663566 NPI number — JAYLEEN MARIE MALAVE CARTAGENA MPHE

Table of content: JAYLEEN MARIE MALAVE CARTAGENA MPHE (NPI 1609663566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609663566 NPI number — JAYLEEN MARIE MALAVE CARTAGENA MPHE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALAVE CARTAGENA
Provider First Name:
JAYLEEN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MPHE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609663566
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1252
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARTANBURG
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29304-1252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-707-2832
Provider Business Mailing Address Fax Number:
864-562-4117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
129 DILLON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29307-1017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-582-7588
Provider Business Practice Location Address Fax Number:
864-562-4117
Provider Enumeration Date:
04/23/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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