Healthcare Provider Details

I. General information

NPI: 1174934897
Provider Name (Legal Business Name): GURTEJ MALHI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

782 E HARDING WAY
STOCKTON CA
95204-6101
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 209-546-5200
  • Fax: 209-466-1982
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA137082
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: