Provider Demographics
NPI:1851425862
Name:MALINI SOOGOOR, M.D. INC
Entity Type:Organization
Organization Name:MALINI SOOGOOR, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MALINI
Authorized Official - Middle Name:
Authorized Official - Last Name:SOOGOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-520-1191
Mailing Address - Street 1:PO BOX 77790
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92877-0126
Mailing Address - Country:US
Mailing Address - Phone:800-626-2468
Mailing Address - Fax:951-272-9924
Practice Address - Street 1:1687 ERRINGER RD STE 215
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065
Practice Address - Country:US
Practice Address - Phone:805-520-1191
Practice Address - Fax:805-426-8046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 81723207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A817230Medicaid
CAW20806Medicare PIN