Healthcare Provider Details

I. General information

NPI: 1366339533
Provider Name (Legal Business Name): SUSAN MALAL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5912 SANTA MONICA BLVD
LOS ANGELES CA
90038-2043
US

IV. Provider business mailing address

2019 SATURN ST
MONTEREY PARK CA
91755-7415
US

V. Phone/Fax

Practice location:
  • Phone: 323-461-3888
  • Fax:
Mailing address:
  • Phone: 323-724-0019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95038598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: