Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 22760 | CA |
NPI | 1144213729 |
---|---|
Provider Name | Dr. Julie Ann Malley |
First Address | Mission Viejo, CA 92691-6704 |
Second Address | Mission Viejo, CA 92691-6704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2005 |
Last Update Date | 08/07/2007 |