Healthcare Provider Details

I. General information

NPI: 1710840418
Provider Name (Legal Business Name): ROMMY MALAEB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1162 MONTGOMERY DR FL 2
SANTA ROSA CA
95405-4802
US

IV. Provider business mailing address

939 DANA CIR
LIVERMORE CA
94550-3781
US

V. Phone/Fax

Practice location:
  • Phone: 707-890-4100
  • Fax:
Mailing address:
  • Phone: 925-487-2386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: