Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | A91553 | CA |
NPI | 1154353969 |
---|---|
Provider Name | Darren Jay Malinoski |
First Address | Los Angeles, CA 90048 |
Second Address | Los Angeles, CA 90048 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 07/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A91553 | MEDICAL LICENSE (01) | CA |