Provider Demographics
NPI:1891739348
Name:MALEK, REZA (MD)
Entity Type:Individual
Prefix:
First Name:REZA
Middle Name:
Last Name:MALEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2520 SAMARITAN DR STE 104B
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4106
Mailing Address - Country:US
Mailing Address - Phone:408-645-7800
Mailing Address - Fax:408-645-7800
Practice Address - Street 1:701 E EL CAMINO REAL FL 3
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2833
Practice Address - Country:US
Practice Address - Phone:650-404-8445
Practice Address - Fax:650-404-8447
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG839762085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG83976OtherMEDICAL LICENSE
CAF43056Medicare UPIN