Healthcare Provider Details

I. General information

NPI: 1104447622
Provider Name (Legal Business Name): MALALAI ZOLTANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 SHAW AVE
CLOVIS CA
93611-4192
US

IV. Provider business mailing address

1111 E SPRUCE AVE STE 431
FRESNO CA
93720-3330
US

V. Phone/Fax

Practice location:
  • Phone: 559-450-5880
  • Fax: 559-450-5881
Mailing address:
  • Phone: 559-450-7449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA186627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: