Provider Demographics
NPI:1861673873
Name:MALALUAN, GIL MAGTIBAY (DMD)
Entity Type:Individual
Prefix:
First Name:GIL
Middle Name:MAGTIBAY
Last Name:MALALUAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 S AZUSA AVE APT 122
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-1601
Mailing Address - Country:US
Mailing Address - Phone:310-709-1967
Mailing Address - Fax:
Practice Address - Street 1:1855 N HACIENDA BLVD
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-1125
Practice Address - Country:US
Practice Address - Phone:626-917-5980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA565701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice