Healthcare Provider Details

I. General information

NPI: 1659328185
Provider Name (Legal Business Name): MALINI SOOGOOR M.D.,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1687 ERRINGER RD STE 215
SIMI VALLEY CA
93065
US

IV. Provider business mailing address

PO BOX 77790
CORONA CA
92877-0126
US

V. Phone/Fax

Practice location:
  • Phone: 805-520-1191
  • Fax: 805-426-8046
Mailing address:
  • Phone: 951-278-5590
  • Fax: 951-272-9924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA81723
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: