Provider Demographics
NPI:1992828826
Name:ABDELMALEK, EZZAT (MD)
Entity Type:Individual
Prefix:DR
First Name:EZZAT
Middle Name:
Last Name:ABDELMALEK
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 1:24952 BEACHWALK WAY
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-1911
Mailing Address - Country:US
Mailing Address - Phone:949-248-1273
Mailing Address - Fax:949-248-1852
Practice Address - Street 1:24952 BEACHWALK WAY
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-1911
Practice Address - Country:US
Practice Address - Phone:949-248-1273
Practice Address - Fax:949-248-1852
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA316502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry