Healthcare Provider Details

I. General information

NPI: 1639055833
Provider Name (Legal Business Name): SEAN THOMAS MALONE SR. RADT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 E JEFFERSON ST
CARSON CA
90810-1519
US

IV. Provider business mailing address

2515 E JEFFERSON ST
CARSON CA
90810-1519
US

V. Phone/Fax

Practice location:
  • Phone: 310-830-7803
  • Fax: 310-830-6606
Mailing address:
  • Phone: 310-830-7803
  • Fax: 310-830-6606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: