Provider Demographics
NPI:1437705365
Name:SALIEVA, MALIKA
Entity Type:Individual
Prefix:
First Name:MALIKA
Middle Name:
Last Name:SALIEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21330 PARTHENIA ST APT 201
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-1697
Mailing Address - Country:US
Mailing Address - Phone:818-857-9957
Mailing Address - Fax:
Practice Address - Street 1:21330 PARTHENIA ST APT 201
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-1697
Practice Address - Country:US
Practice Address - Phone:818-857-9957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA91557205EMedicaid