Provider Demographics
NPI:1730113408
Name:MALEKI, COMRON (MD)
Entity Type:Individual
Prefix:
First Name:COMRON
Middle Name:
Last Name:MALEKI
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 1:2230 LYNN RD
Mailing Address - Street 2:105
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1901
Mailing Address - Country:US
Mailing Address - Phone:805-496-6611
Mailing Address - Fax:805-494-6756
Practice Address - Street 1:2230 LYNN RD
Practice Address - Street 2:105
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1901
Practice Address - Country:US
Practice Address - Phone:805-496-6611
Practice Address - Fax:805-494-6756
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36282207N00000X, 207ND0101X, 207NS0135X, 207ND0900X, 207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA84870Medicare UPIN
CAWA36282BMedicare PIN
CAW14434Medicare ID - Type Unspecified