Healthcare Provider Details

I. General information

NPI: 1588827067
Provider Name (Legal Business Name): PHILIP JOSEPH MALOUF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2008
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 TUOLUMNE ST
VALLEJO CA
94590-5700
US

IV. Provider business mailing address

1310 CLUB DRIVE
VALLEJO CA
94592
US

V. Phone/Fax

Practice location:
  • Phone: 707-553-5509
  • Fax: 707-553-5658
Mailing address:
  • Phone: 707-638-5205
  • Fax: 707-638-5225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA103552
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: