Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | G67771 | CA |
NPI | 1336297324 |
---|---|
Provider Name | Gregory B. Maletis |
First Address | Baldwin Park, CA 91706-5806 |
Second Address | Baldwin Park, CA 91706-5806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 30/11/2021 |