Provider Demographics
NPI:1740773530
Name:DADSETAN, MALIA (DO)
Entity Type:Individual
Prefix:
First Name:MALIA
Middle Name:
Last Name:DADSETAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17251 17TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-1963
Mailing Address - Country:US
Mailing Address - Phone:657-241-8580
Mailing Address - Fax:714-665-4608
Practice Address - Street 1:17251 17TH ST STE B
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-1963
Practice Address - Country:US
Practice Address - Phone:657-241-8580
Practice Address - Fax:714-665-4608
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD4475110207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine