Provider Demographics
NPI:1710206420
Name:MALHOTRA, AJAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:AJAY
Middle Name:
Last Name:MALHOTRA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5014 CHESEBRO RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-2278
Mailing Address - Country:US
Mailing Address - Phone:888-691-3223
Mailing Address - Fax:
Practice Address - Street 1:5014 CHESEBRO RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-2278
Practice Address - Country:US
Practice Address - Phone:888-691-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12365103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic