Provider Demographics
NPI:1184036030
Name:MALEK, NATALIA C (SLP)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:C
Last Name:MALEK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25102 JEFFERSON AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-1707
Mailing Address - Country:US
Mailing Address - Phone:951-265-9553
Mailing Address - Fax:951-461-7975
Practice Address - Street 1:577 E ELDER ST
Practice Address - Street 2:SUITE I
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3079
Practice Address - Country:US
Practice Address - Phone:760-723-2687
Practice Address - Fax:760-723-2689
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22694235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB230243Medicare PIN
CACA145890Medicare PIN
CACA145891Medicare PIN