Provider Demographics
NPI:1518075944
Name:SAFOUH MALHIS MD
Entity Type:Organization
Organization Name:SAFOUH MALHIS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAFOUH
Authorized Official - Middle Name:
Authorized Official - Last Name:MALHIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-659-0098
Mailing Address - Street 1:PO BOX 5005
Mailing Address - Street 2:PMB 45
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067
Mailing Address - Country:US
Mailing Address - Phone:760-659-0098
Mailing Address - Fax:
Practice Address - Street 1:100 SUSAN DR
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-2826
Practice Address - Country:US
Practice Address - Phone:814-255-1963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-062912-L207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
082836OtherMEDICARE GROUP
PA999440OtherGROUP HIGHMARK
PA999440OtherGROUP HIGHMARK