1518075944 NPI number — SAFOUH MALHIS MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518075944 NPI number — SAFOUH MALHIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAFOUH MALHIS MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518075944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5005
Provider Second Line Business Mailing Address:
PMB 45
Provider Business Mailing Address City Name:
RANCHO SANTA FE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-659-0098
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 SUSAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15905-2826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-255-1963
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MALHIS
Authorized Official First Name:
SAFOUH
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
760-659-0098

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  MD-062912-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 082836 . This is a "MEDICARE GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 999440 . This is a "GROUP HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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