1700921426 NPI number — DR. NAJLA ELIAS MALAK-MAJDALANI O.D.

Table of content: DR. NAJLA ELIAS MALAK-MAJDALANI O.D. (NPI 1700921426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700921426 NPI number — DR. NAJLA ELIAS MALAK-MAJDALANI O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALAK-MAJDALANI
Provider First Name:
NAJLA
Provider Middle Name:
ELIAS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

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:
1700921426
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
64 AUTUMNWIND CT.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN RAMON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94583
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-328-1015
Provider Business Mailing Address Fax Number:
510-784-0433

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
64 AUTUMNWIND CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN RAMON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94583-5310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-328-1015
Provider Business Practice Location Address Fax Number:
510-784-0433
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  9424T , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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