MEDICARE: MR. JOHN DANIEL MALAN AUD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237600000X	Audiologist-Hearing Aid Fitter	AU1728	CA
2	231H00000X	Audiologist	AU1728	CA

General Provider Information

NPI Number	:	1194862219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN DANIEL MALAN AUD

Provider Business Mailing Address
First Line	:	1717 SIMI TOWN CENTER WAY STE 3
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-8408
Country	:	US
Telephone Number	:	805-579-9324
Fax Number	:	805-579-9647

Provider Business Practice Location Address
First Line	:	1717 SIMI TOWN CENTER WAY STE 3
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-8408
Country	:	US
Telephone Number	:	805-579-9324
Fax Number	:	805-579-9647

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	12/19/2019

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