Healthcare Provider Details

I. General information

NPI: 1952959207
Provider Name (Legal Business Name): DOROTHY DAWN MALSACK R.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PERGOLA
IRVINE CA
92612
US

IV. Provider business mailing address

281 ESPLANADE
IRVINE CA
92612
US

V. Phone/Fax

Practice location:
  • Phone: 949-371-6947
  • Fax:
Mailing address:
  • Phone: 310-993-1197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number870637
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: