Provider Demographics
NPI:1033613104
Name:MALER, GREG ELLIS (DO)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:ELLIS
Last Name:MALER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 E HOLT AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-5822
Mailing Address - Country:US
Mailing Address - Phone:909-630-7927
Mailing Address - Fax:909-620-6719
Practice Address - Street 1:1450 E HOLT AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-5822
Practice Address - Country:US
Practice Address - Phone:909-630-7927
Practice Address - Fax:909-620-6719
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A17625207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine