Healthcare Provider Details

I. General information

NPI: 1700285103
Provider Name (Legal Business Name): SAVERIO MALIK ROBERTO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 HOEN AVE
SANTA ROSA CA
95405
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 707-526-3360
  • Fax: 707-573-5406
Mailing address:
  • Phone: 707-526-3360
  • Fax: 707-573-5406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A17436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: