Provider Demographics
NPI:1255670642
Name:MALIK, MUSARRAT (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MUSARRAT
Middle Name:
Last Name:MALIK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MUSARRAT
Other - Middle Name:
Other - Last Name:MALIK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:8820 GREYHAWK DR
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-8842
Mailing Address - Country:US
Mailing Address - Phone:916-872-4184
Mailing Address - Fax:916-872-4184
Practice Address - Street 1:8820 GREYHAWK DR
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-8842
Practice Address - Country:US
Practice Address - Phone:916-872-4184
Practice Address - Fax:916-872-4184
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22416363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant