Healthcare Provider Details

I. General information

NPI: 1114982568
Provider Name (Legal Business Name): KATHRYN EMILY MALONE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SAN PABLO AVE # 310
BERKELEY CA
94702
US

IV. Provider business mailing address

1450 TREAT BLVD # 300
WALNUT CREEK CA
94597-2168
US

V. Phone/Fax

Practice location:
  • Phone: 510-985-5020
  • Fax:
Mailing address:
  • Phone: 925-952-2855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number00A532520
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: