1891324521 NPI number — DR. JOSEPH ABDELMALAK DPM

Table of content: DR. JOSEPH ABDELMALAK DPM (NPI 1891324521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891324521 NPI number — DR. JOSEPH ABDELMALAK DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABDELMALAK
Provider First Name:
JOSEPH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

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:
1891324521
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19360 RINALDI ST STE 363
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTER RANCH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91326-1607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-895-8716
Provider Business Mailing Address Fax Number:
818-475-1406

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
903 W 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXNARD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93030-6755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
747-263-9696
Provider Business Practice Location Address Fax Number:
805-263-4090
Provider Enumeration Date:
04/04/2020

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: 213ES0103X , with the licence number:  25MD00364100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: N007260-01 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: E5948 , 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)