Provider Demographics
NPI:1285024232
Name:RICHARD MALOTKY, MD., INC.
Entity Type:Organization
Organization Name:RICHARD MALOTKY, MD., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MALOTKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-244-7707
Mailing Address - Street 1:1800 BUENAVENTURA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-3700
Mailing Address - Country:US
Mailing Address - Phone:530-244-7707
Mailing Address - Fax:530-244-7196
Practice Address - Street 1:1800 BUENAVENTURA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3700
Practice Address - Country:US
Practice Address - Phone:530-244-7707
Practice Address - Fax:530-244-7196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54477207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty