Provider Demographics
NPI:1982656526
Name:MALHOTRA, SAMEER M (MD)
Entity Type:Individual
Prefix:
First Name:SAMEER
Middle Name:M
Last Name:MALHOTRA
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 1:8540 S SEPULVEDA BLVD
Mailing Address - Street 2:# 911
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3807
Mailing Address - Country:US
Mailing Address - Phone:310-670-9119
Mailing Address - Fax:310-670-7282
Practice Address - Street 1:8540 S SEPULVEDA BLVD
Practice Address - Street 2:# 911
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3807
Practice Address - Country:US
Practice Address - Phone:310-670-9119
Practice Address - Fax:310-670-7282
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76279174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A762790Medicaid
CAI54302Medicare UPIN
CA00A762790Medicaid
CAW10032Medicare PIN
CAWA76279AMedicare PIN