Provider Demographics
NPI:1508333873
Name:MALIT, ANDREW CANTOS (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:CANTOS
Last Name:MALIT
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:409 BRISTOL WAY
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-6156
Mailing Address - Country:US
Mailing Address - Phone:951-415-5905
Mailing Address - Fax:
Practice Address - Street 1:409 BRISTOL WAY
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-6156
Practice Address - Country:US
Practice Address - Phone:951-415-5905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical