Provider Demographics
NPI:1780098384
Name:MALHOTRA, DEVIKA (MD)
Entity type:Individual
Prefix:
First Name:DEVIKA
Middle Name:
Last Name:MALHOTRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11022 N 28TH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-5634
Mailing Address - Country:US
Mailing Address - Phone:623-462-1981
Mailing Address - Fax:623-400-3348
Practice Address - Street 1:20221 N 67TH AVE STE E3
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-0602
Practice Address - Country:US
Practice Address - Phone:623-462-1981
Practice Address - Fax:623-400-3348
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ62149208000000X
MI4301105978390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics