Healthcare Provider Details

I. General information

NPI: 1518263128
Provider Name (Legal Business Name): RENA D MALIK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 WESTCLIFF DR STE 201
NEWPORT BEACH CA
92660-5518
US

IV. Provider business mailing address

2108 N ST STE 5892
SACRAMENTO CA
95816-5712
US

V. Phone/Fax

Practice location:
  • Phone: 949-610-0866
  • Fax: 949-569-9606
Mailing address:
  • Phone: 949-610-0866
  • Fax: 949-569-9606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberC186961
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberR9098
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberTPME5484
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number101278199
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number294488
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberD85712
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: