Provider Demographics
NPI:1689705386
Name:MALIK, SAVITA (MD)
Entity Type:Individual
Prefix:
First Name:SAVITA
Middle Name:
Last Name:MALIK
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 1776
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91708-1776
Mailing Address - Country:US
Mailing Address - Phone:909-590-5136
Mailing Address - Fax:909-465-5603
Practice Address - Street 1:12590 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3507
Practice Address - Country:US
Practice Address - Phone:909-590-5136
Practice Address - Fax:909-465-5603
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44708174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44708OtherSTATE LICENSE
CA00A447081Medicaid
CAA44708OtherSTATE LICENSE
CAE50928Medicare UPIN