Healthcare Provider Details

I. General information

NPI: 1740262302
Provider Name (Legal Business Name): GEETA K MALIK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 1ST ST W SUITE H
SONOMA CA
95476-7045
US

IV. Provider business mailing address

651 1ST ST W SUITE H
SONOMA CA
95476-7045
US

V. Phone/Fax

Practice location:
  • Phone: 707-938-3870
  • Fax: 707-938-3895
Mailing address:
  • Phone: 707-938-3870
  • Fax: 707-938-3895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberK5147
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG79541
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: