Healthcare Provider Details

I. General information

NPI: 1366616799
Provider Name (Legal Business Name): MALAIKA STOLL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 11/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 CAMINO ENCINAS
ORINDA CA
94563-3304
US

IV. Provider business mailing address

PO BOX 255789
SACRAMENTO CA
95865-5789
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-8180
  • Fax: 925-254-0687
Mailing address:
  • Phone: 916-854-6975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA118379
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: