Healthcare Provider Details

I. General information

NPI: 1356223895
Provider Name (Legal Business Name): NICOLAS MAALOUF DO MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S BUENA VISTA ST
BURBANK CA
91505
US

IV. Provider business mailing address

14622 VENTURA BLVD STE 102 PO BOX 713
SHERMAN OAKS CA
91403-3662
US

V. Phone/Fax

Practice location:
  • Phone: 818-843-5111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NICOLAS MAALOUF
Title or Position: PHYSICIAN
Credential:
Phone: 818-744-2291