Healthcare Provider Details

I. General information

NPI: 1003444506
Provider Name (Legal Business Name): SAHANA MALIK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 3RD AVE STE 420
SAN DIEGO CA
92103-2140
US

IV. Provider business mailing address

4033 3RD AVE STE 420
SAN DIEGO CA
92103-2140
US

V. Phone/Fax

Practice location:
  • Phone: 619-294-9292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2084P800X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: