Healthcare Provider Details

I. General information

NPI: 1972895027
Provider Name (Legal Business Name): MENYOLI MICHAEL MALAFA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E CESAR E CHAVEZ AVE STE 2200
LOS ANGELES CA
90033-2476
US

IV. Provider business mailing address

1700 E CESAR E CHAVEZ AVE STE 2200
LOS ANGELES CA
90033-2476
US

V. Phone/Fax

Practice location:
  • Phone: 323-264-7600
  • Fax:
Mailing address:
  • Phone: 323-264-7600
  • Fax: 323-261-8027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberA149588
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberA149588
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberA149588
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberA149588
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: