Provider Demographics
NPI:1427226570
Name:MALUFAU, FESO BENJAMIN JR (BA PSYCHOLOGY)
Entity Type:Individual
Prefix:MR
First Name:FESO
Middle Name:BENJAMIN
Last Name:MALUFAU
Suffix:JR
Gender:M
Credentials:BA PSYCHOLOGY
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1133 COLOMA WAY, SUITE C
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661
Mailing Address - Country:US
Mailing Address - Phone:916-774-6664
Mailing Address - Fax:
Practice Address - Street 1:1133 COLOMA WAY STE C
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4480
Practice Address - Country:US
Practice Address - Phone:916-774-6664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)