Provider Demographics
NPI:1851969315
Name:FARAGALLAH, MALAK (MD)
Entity Type:Individual
Prefix:
First Name:MALAK
Middle Name:
Last Name:FARAGALLAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5202 AUBURN ST APT 227
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-1457
Mailing Address - Country:US
Mailing Address - Phone:806-441-6882
Mailing Address - Fax:
Practice Address - Street 1:3601 4TH ST STOP 6238
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-6238
Practice Address - Country:US
Practice Address - Phone:806-743-2669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program