Healthcare Provider Details

I. General information

NPI: 1437588720
Provider Name (Legal Business Name): MALIA COMSTOCK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE M631
SAN FRANCISCO CA
94143-0106
US

IV. Provider business mailing address

505 PARNASSUS AVE M631
SAN FRANCISCO CA
94143-0106
US

V. Phone/Fax

Practice location:
  • Phone: 415-502-0530
  • Fax: 415-353-3729
Mailing address:
  • Phone: 415-502-0530
  • Fax: 415-353-3729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number16757
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: