Healthcare Provider Details

I. General information

NPI: 1720154578
Provider Name (Legal Business Name): BETTY JOAN MALY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4282 GENESEE AVE STE 302
SAN DIEGO CA
92117-4946
US

IV. Provider business mailing address

4282 GENESEE AVE STE 302
SAN DIEGO CA
92117-4946
US

V. Phone/Fax

Practice location:
  • Phone: 858-450-1122
  • Fax: 858-571-3649
Mailing address:
  • Phone: 858-450-1122
  • Fax: 858-571-3649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberG55531
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: