Healthcare Provider Details

I. General information

NPI: 1730984402
Provider Name (Legal Business Name): ABIGAIL LYNN MALECOT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ABIGAIL LYNN HOLMES

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24910 LAS BRISAS RD STE 105
MURRIETA CA
92562-4010
US

IV. Provider business mailing address

3436 BAYSIDE WALK
SAN DIEGO CA
92109-7544
US

V. Phone/Fax

Practice location:
  • Phone: 951-231-1385
  • Fax:
Mailing address:
  • Phone: 325-370-6368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95033997
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: