Provider Demographics
NPI:1841220571
Name:MALARO, MAGIE M (MD)
Entity Type:Individual
Prefix:
First Name:MAGIE
Middle Name:M
Last Name:MALARO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 PIER AVE
Mailing Address - Street 2:SUITE B138
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-3949
Mailing Address - Country:US
Mailing Address - Phone:310-376-8116
Mailing Address - Fax:310-376-8166
Practice Address - Street 1:703 PIER AVE
Practice Address - Street 2:SUITE B138
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-3949
Practice Address - Country:US
Practice Address - Phone:310-376-8116
Practice Address - Fax:310-376-8166
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG851452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G851450OtherBLUE SHIELD
CA00G851450Medicaid
CA00G851452Medicare ID - Type Unspecified
CAWG85145IMedicare ID - Type Unspecified
CA00G851450Medicare ID - Type Unspecified
CAWG85145GMedicare ID - Type Unspecified
CA00G851451Medicare ID - Type Unspecified
CA00G851450OtherBLUE SHIELD
CAG66150Medicare UPIN
CAWG85145HMedicare ID - Type Unspecified
CA00G851450Medicaid