Provider Demographics
NPI:1245964345
Name:AHADI, MALIA
Entity type:Individual
Prefix:DR
First Name:MALIA
Middle Name:
Last Name:AHADI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15488 AVENIDA RORRAS
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4513
Mailing Address - Country:US
Mailing Address - Phone:914-800-4918
Mailing Address - Fax:
Practice Address - Street 1:10717 CAMINO RUIZ STE 164
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-2362
Practice Address - Country:US
Practice Address - Phone:619-635-3400
Practice Address - Fax:619-878-6362
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19445171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist