Healthcare Provider Details

I. General information

NPI: 1891739348
Provider Name (Legal Business Name): REZA MALEK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E EL CAMINO REAL FL 3
MOUNTAIN VIEW CA
94040-2833
US

IV. Provider business mailing address

2520 SAMARITAN DR STE 104B
SAN JOSE CA
95124-4106
US

V. Phone/Fax

Practice location:
  • Phone: 650-404-8445
  • Fax: 650-404-8447
Mailing address:
  • Phone: 408-645-7800
  • Fax: 408-645-7800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberG83976
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: