Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 125053433 | IL |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 2011033713 | MO |
Y | 2081S0010X | Sports Medicine | MD163117 | OR |
Y | 213ES0000X | Sports Medicine | MD163117 | OR |
NPI | 1023209897 |
---|---|
Provider Name | Dr. Lynette Santos Malik |
First Address | Portland, OR 97227-1106 |
Second Address | Portland, OR 97227-1106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2007 |
Last Update Date | 13/11/2013 |