Healthcare Provider Details

I. General information

NPI: 1619953502
Provider Name (Legal Business Name): NADIA S MALIK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NADIA S MALIK MD

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SERENO DR
VALLEJO CA
94589-2441
US

IV. Provider business mailing address

1351 ROYAL CREEK CT
PLEASANTON CA
94566-3424
US

V. Phone/Fax

Practice location:
  • Phone: 707-651-2259
  • Fax: 916-703-2274
Mailing address:
  • Phone: 925-485-9711
  • Fax: 925-485-9711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License NumberS12.2005
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: