Healthcare Provider Details

I. General information

NPI: 1912254103
Provider Name (Legal Business Name): MARK P MALAY PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 S EL CAMINO REAL #207
OCEANSIDE CA
92054-6248
US

IV. Provider business mailing address

2604 EL CAMINO REAL STE B #291
CARLSBAD CA
92008-1205
US

V. Phone/Fax

Practice location:
  • Phone: 760-644-2482
  • Fax:
Mailing address:
  • Phone: 760-644-2482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC35611
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY26870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: