Healthcare Provider Details

I. General information

NPI: 1982651006
Provider Name (Legal Business Name): IRENE MALEK MD PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 11/13/2021
Certification Date: 11/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 ATLANTIC AVE
LONG BEACH CA
90807-3418
US

IV. Provider business mailing address

PO BOX 1856
LOS ALAMITOS CA
90720-1856
US

V. Phone/Fax

Practice location:
  • Phone: 562-492-9288
  • Fax: 562-595-9346
Mailing address:
  • Phone: 310-792-3914
  • Fax: 855-898-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IRENE A MALEK
Title or Position: PRESIDENT
Credential: MD
Phone: 562-492-9288