Healthcare Provider Details

I. General information

NPI: 1538861281
Provider Name (Legal Business Name): NICHOLAS MAALOUF DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 09/18/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4520 BUSINESS CENTER DR 4520 BUSINESS CENTER DR
FAIRFIELD CA
94534
US

IV. Provider business mailing address

4520 BUSINESS CENTER DR 4520 BUSINESS CENTER DR
FAIRFIELD CA
94534
US

V. Phone/Fax

Practice location:
  • Phone: 707-646-3500
  • Fax:
Mailing address:
  • Phone: 707-646-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A24747
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: