Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | PT30454 | CA |
NPI | 1518909241 |
---|---|
Provider Name | Erin Malecha |
First Address | Fountain Valley, CA 92728-8125 |
Second Address | Fountain Valley, CA 92708-4210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 08/07/2007 |