Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | A21089 | CA |
Y | 208800000X | Urologist | A21089 | CA |
NPI | 1104263540 |
---|---|
Provider Name | Dr. Irving Malis |
First Address | Calabasas, CA 91302-1715 |
Second Address | Calabasas, CA 91302-1715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2013 |
Last Update Date | 24/05/2013 |