Provider Demographics
NPI:1700285103
Name:ROBERTO, SAVERIO MALIK (DO)
Entity Type:Individual
Prefix:
First Name:SAVERIO
Middle Name:MALIK
Last Name:ROBERTO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:707-526-3360
Mailing Address - Fax:707-573-5406
Practice Address - Street 1:4700 HOEN AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405
Practice Address - Country:US
Practice Address - Phone:707-526-3360
Practice Address - Fax:707-573-5406
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A17436207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A17436OtherSTATE MEDICAL LICENSE