Basic Information
| Provider Information | |||||||||
| NPI: | 1588950513 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALLEK | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | DE TOLEDO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 668 | ||||||||
| Address2: | |||||||||
| City: | ARVADA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800010668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034229438 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1600 PRAIRIE CENTER PKWY | ||||||||
| Address2: | |||||||||
| City: | BRIGHTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806014006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034229438 | ||||||||
| FaxNumber: | 3034229474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2011 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | ME123239 | FL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | TRN15938 | FL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 0056931 | CO | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 014756100 | 05 | FL | MEDICAID | 1588950513 | 05 | CO | MEDICAID | TRN15938 | 01 | FL | TRAINING LICENCE | OTHER |