Provider Demographics
NPI:1033389630
Name:MALIK, FAUZIA (PA)
Entity Type:Individual
Prefix:
First Name:FAUZIA
Middle Name:
Last Name:MALIK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8931 ASHTON LOOP NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2959
Mailing Address - Country:US
Mailing Address - Phone:505-856-5882
Mailing Address - Fax:
Practice Address - Street 1:8931 ASHTON LOOP NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-2959
Practice Address - Country:US
Practice Address - Phone:505-856-5882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2007-0047363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant