MEDICARE: ALEXANDER MICHAEL MALAKI

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	106S00000X	Behavior Technician		CA

General Provider Information

NPI Number	:	1710425590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER MICHAEL MALAKI

Provider Business Mailing Address
First Line	:	1805 N ST APT 1
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95811-5141
Country	:	US
Telephone Number	:	916-833-2485
Fax Number	:

Provider Business Practice Location Address
First Line	:	1805 N ST APT 1
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95811-5141
Country	:	US
Telephone Number	:	916-833-2485
Fax Number	:

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

Provider Enumeration Date	:	02/01/2017
Last Update Date	:	02/01/2017

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