Provider Demographics
NPI:1942489216
Name:ALAN E. MALKI, M.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ALAN E. MALKI, M.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:DICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-833-6676
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43969174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0079160Medicaid
CAGR0079161Medicaid
CAGR0079161Medicaid
CAZZZ13778ZMedicare PIN
CAZZZ13779ZMedicare PIN
CAA49510Medicare UPIN