Healthcare Provider Details

I. General information

NPI: 1679583744
Provider Name (Legal Business Name): ASHISH MALHOTRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19341 BEAR VALLEY RD SUITE 101
APPLE VALLEY CA
92308
US

IV. Provider business mailing address

19341 BEAR VALLEY RD SUITE 101
APPLE VALLEY CA
92308-5151
US

V. Phone/Fax

Practice location:
  • Phone: 760-810-7778
  • Fax: 760-810-7780
Mailing address:
  • Phone: 760-810-7778
  • Fax: 760-810-7780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA91216
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA91216
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: