Provider Demographics
NPI:1942271226
Name:MALICDEM, ANGELICA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELICA
Middle Name:
Last Name:MALICDEM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 LOMITA BLVD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5105
Mailing Address - Country:US
Mailing Address - Phone:310-784-6954
Mailing Address - Fax:310-326-5679
Practice Address - Street 1:2841 LOMITA BLVD
Practice Address - Street 2:SUITE 135
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5105
Practice Address - Country:US
Practice Address - Phone:310-784-6954
Practice Address - Fax:310-326-5679
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA054671207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G57000Medicare UPIN
WA54671CMedicare PIN