Provider Demographics
NPI:1659328185
Name:SOOGOOR, MALINI (MD,)
Entity Type:Individual
Prefix:DR
First Name:MALINI
Middle Name:
Last Name:SOOGOOR
Suffix:
Gender:F
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:PO BOX 77790
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92877-0126
Mailing Address - Country:US
Mailing Address - Phone:951-278-5590
Mailing Address - Fax:951-272-9924
Practice Address - Street 1:1687 ERRINGER RD STE 215
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065
Practice Address - Country:US
Practice Address - Phone:805-520-1191
Practice Address - Fax:805-426-8046
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81723207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1851425862OtherMEDI-CAL
CAA81723OtherSTATE LICENSE
CAI55426OtherUPIN
CA1851425862OtherMEDI-CAL