Provider Demographics
NPI:1801008701
Name:MALCOFF, BREE ANN
Entity Type:Individual
Prefix:
First Name:BREE
Middle Name:ANN
Last Name:MALCOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 CLOVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-6914
Mailing Address - Country:US
Mailing Address - Phone:760-715-4856
Mailing Address - Fax:
Practice Address - Street 1:18945 FM 2252
Practice Address - Street 2:STE 115
Practice Address - City:GARDEN RIDGE
Practice Address - State:TX
Practice Address - Zip Code:78266-2797
Practice Address - Country:US
Practice Address - Phone:210-651-0029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5540-05374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician