Healthcare Provider Details

I. General information

NPI: 1033647292
Provider Name (Legal Business Name): VIDUR MALIK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 CABRILLO HWY S STE 100A
HALF MOON BAY CA
94019-1738
US

IV. Provider business mailing address

225 CABRILLO HWY S STE 100A
HALF MOON BAY CA
94019-1738
US

V. Phone/Fax

Practice location:
  • Phone: 510-789-8037
  • Fax:
Mailing address:
  • Phone: 510-789-8037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number127957
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: