Provider Demographics
NPI:1518959162
Name:MALINICK, CHARLES D (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:D
Last Name:MALINICK
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 1:3350 E BIRCH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-6264
Mailing Address - Country:US
Mailing Address - Phone:714-528-9592
Mailing Address - Fax:714-528-9606
Practice Address - Street 1:3350 E BIRCH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-6264
Practice Address - Country:US
Practice Address - Phone:714-528-9592
Practice Address - Fax:714-528-9606
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG594302084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD47104Medicare UPIN
CAG59430Medicare ID - Type Unspecified