Provider Demographics
NPI:1578164844
Name:AHMED, MALAZ (RRT)
Entity Type:Individual
Prefix:
First Name:MALAZ
Middle Name:
Last Name:AHMED
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 VICTOR ST APT 11
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-4697
Mailing Address - Country:US
Mailing Address - Phone:619-277-9356
Mailing Address - Fax:
Practice Address - Street 1:8380 CENTER DR STE E
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2952
Practice Address - Country:US
Practice Address - Phone:619-466-6077
Practice Address - Fax:619-466-6118
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA431012278G1100X
431012279G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeneral Care
No2278G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeneral Care