Healthcare Provider Details

I. General information

NPI: 1811285414
Provider Name (Legal Business Name): DR. STEPHEN MALUTICH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2011
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 STOCKTON BLVD STE 207
SACRAMENTO CA
95816-7092
US

IV. Provider business mailing address

2315 STOCKTON BLVD
SACRAMENTO CA
95817-2201
US

V. Phone/Fax

Practice location:
  • Phone: 916-878-3495
  • Fax:
Mailing address:
  • Phone: 916-703-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberA126239
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License NumberA126239
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207UN0903X
TaxonomyIn Vivo & In Vitro Nuclear Medicine Physician
License NumberA126239
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberA126239
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA126239
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberA126239
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: