Healthcare Provider Details

I. General information

NPI: 1750325171
Provider Name (Legal Business Name): JEREMIAH JOHN MALONEY V D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44274 GEORGE CUSHMAN CT STE 208
TEMECULA CA
92592-5945
US

IV. Provider business mailing address

41327 CRESTA VERDE CT
TEMECULA CA
92592-4403
US

V. Phone/Fax

Practice location:
  • Phone: 951-501-4200
  • Fax:
Mailing address:
  • Phone: 951-591-1840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20A8468
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: