Healthcare Provider Details

I. General information

NPI: 1457963639
Provider Name (Legal Business Name): PAIGE MALONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 10/15/2024
Certification Date: 08/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44444 20TH ST W
LANCASTER CA
93534-2714
US

IV. Provider business mailing address

PO BOX 5754
LANCASTER CA
93539-5754
US

V. Phone/Fax

Practice location:
  • Phone: 661-951-0070
  • Fax:
Mailing address:
  • Phone: 661-523-5234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: