Provider Demographics
NPI:1205021045
Name:PERRY MALOFF, M.D., A MEDICAL CORP
Entity Type:Organization
Organization Name:PERRY MALOFF, M.D., A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MALOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-915-7581
Mailing Address - Street 1:100 S CITRUS AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-2653
Mailing Address - Country:US
Mailing Address - Phone:626-915-7581
Mailing Address - Fax:626-915-7588
Practice Address - Street 1:100 S CITRUS AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-2653
Practice Address - Country:US
Practice Address - Phone:626-915-7581
Practice Address - Fax:626-915-7588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40885103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A48387Medicare UPIN
CAW7902Medicare PIN