Healthcare Provider Details

I. General information

NPI: 1689788283
Provider Name (Legal Business Name): FAWAD MALIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1838 EL CAMINO REAL SUITE 208
BURLINGAME CA
94010-3126
US

IV. Provider business mailing address

4104 24TH ST # 521
SAN FRANCISCO CA
94114-3615
US

V. Phone/Fax

Practice location:
  • Phone: 415-775-7766
  • Fax: 650-259-7556
Mailing address:
  • Phone: 415-775-7766
  • Fax: 650-259-7556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA81928
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: