Provider Demographics
NPI:1740751247
Name:YUSUFZAI, MALALAI (NP)
Entity Type:Individual
Prefix:
First Name:MALALAI
Middle Name:
Last Name:YUSUFZAI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 LILAC LN
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-2529
Mailing Address - Country:US
Mailing Address - Phone:916-747-7092
Mailing Address - Fax:
Practice Address - Street 1:529 LILAC LN
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-2529
Practice Address - Country:US
Practice Address - Phone:916-747-7092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-09
Last Update Date:2018-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95010016363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner