Provider Demographics
NPI:1811308448
Name:MALLER, JUSTINE COLETTE (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:JUSTINE
Middle Name:COLETTE
Last Name:MALLER
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 WELCH RD STE 301
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1521
Mailing Address - Country:US
Mailing Address - Phone:650-723-8295
Mailing Address - Fax:
Practice Address - Street 1:700 WELCH RD STE 301
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1521
Practice Address - Country:US
Practice Address - Phone:650-723-8295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-16
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA139239208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics