Provider Demographics
NPI:1124558697
Name:MALIWAT, BLAIRE JARVIE (ND, LAC, RDN)
Entity Type:Individual
Prefix:DR
First Name:BLAIRE
Middle Name:JARVIE
Last Name:MALIWAT
Suffix:
Gender:F
Credentials:ND, LAC, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3296 SPECTRUM
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3372
Mailing Address - Country:US
Mailing Address - Phone:708-829-4387
Mailing Address - Fax:
Practice Address - Street 1:1831 ORANGE AVE STE E
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2839
Practice Address - Country:US
Practice Address - Phone:949-646-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND893175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath