Provider Demographics
NPI:1841854288
Name:JOELLE RABOW MALETIDS LLC
Entity type:Organization
Organization Name:JOELLE RABOW MALETIDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-828-9836
Mailing Address - Street 1:1061 EL MONTE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-2336
Mailing Address - Country:US
Mailing Address - Phone:650-386-6753
Mailing Address - Fax:650-282-3468
Practice Address - Street 1:1061 EL MONTE AVE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2336
Practice Address - Country:US
Practice Address - Phone:650-386-6753
Practice Address - Fax:650-282-3468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1023377017OtherSTATE OF CALIFORNIA