Provider Demographics
NPI:1497867501
Name:MALINAK, JAMES R (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:MALINAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5111 GARFIELD ST
Mailing Address - Street 2:STE A
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-5103
Mailing Address - Country:US
Mailing Address - Phone:619-460-4050
Mailing Address - Fax:619-460-7441
Practice Address - Street 1:5111 GARFIELD ST
Practice Address - Street 2:STE A
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-5103
Practice Address - Country:US
Practice Address - Phone:619-460-4050
Practice Address - Fax:619-460-7441
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52238207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G522380Medicaid
CA00G522380Medicaid
CAG52238Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID