Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | A69875 | CA |
NPI | 1013953892 |
---|---|
Provider Name | Mahmoud Malas |
First Address | San Diego, CA 92193-2410 |
Second Address | La Jolla, CA 92037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 30/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
408917100 | (05) | MD |
H38176 | (02) | MD |