Provider Demographics
NPI:1881687499
Name:MALOOF, GEORGE J JR (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:J
Last Name:MALOOF
Suffix:JR
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 1:1420 OCOTILLO DR
Mailing Address - Street 2:STE A
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4213
Mailing Address - Country:US
Mailing Address - Phone:760-352-3555
Mailing Address - Fax:760-352-7094
Practice Address - Street 1:1420 OCOTILLO DR
Practice Address - Street 2:STE A
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4213
Practice Address - Country:US
Practice Address - Phone:760-352-3555
Practice Address - Fax:760-352-7094
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43052207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A430520Medicaid
CA00A430520Medicaid
E01669Medicare UPIN