Healthcare Provider Details

I. General information

NPI: 1487965950
Provider Name (Legal Business Name): NUSRAT N MALIK MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 CLAUS RD
MODESTO CA
95355-9711
US

IV. Provider business mailing address

3113 JOLIE PRE CIR
MODESTO CA
95356-9315
US

V. Phone/Fax

Practice location:
  • Phone: 209-575-4575
  • Fax: 209-575-4598
Mailing address:
  • Phone: 209-575-4575
  • Fax: 209-575-4598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number54022
License Number StateCA

VIII. Authorized Official

Name: NUSRAT N MALIK
Title or Position: PRESIDENT
Credential: MD
Phone: 209-575-4575