Provider Demographics
NPI:1801932033
Name:JUSTICE, MALIA LEANNE (HEALTH SERVICES TECH)
Entity type:Individual
Prefix:
First Name:MALIA
Middle Name:LEANNE
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:HEALTH SERVICES TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 YERBA BUENA ISLAND ROAD
Mailing Address - Street 2:CGC ASPEN
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94130
Mailing Address - Country:US
Mailing Address - Phone:415-399-3590
Mailing Address - Fax:415-399-3577
Practice Address - Street 1:1 YERBA BUENA RD
Practice Address - Street 2:CGC ASPEN
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94130-1527
Practice Address - Country:US
Practice Address - Phone:415-399-3590
Practice Address - Fax:415-399-3577
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other