Provider Demographics
NPI:1942231998
Name:MALKI, ALAN ELIE (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:ELIE
Last Name:MALKI
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 1:700 E REDLANDS BLVD
Mailing Address - Street 2:U515
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-6109
Mailing Address - Country:US
Mailing Address - Phone:805-687-3744
Mailing Address - Fax:805-687-6048
Practice Address - Street 1:2415 BATH ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4324
Practice Address - Country:US
Practice Address - Phone:805-687-3744
Practice Address - Fax:805-687-6048
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2016-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43969174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0079161Medicaid
CAGR0079160Medicaid
CAZZZ13778ZOtherMEDICARE PIN
CA00G439692OtherMEDICARE INDIVIDUAL PTAN
ZZZ13779ZOtherMEDICARE PIN
CA00G439690Medicaid
CA00G439690Medicaid
CAGR0079161Medicaid