Healthcare Provider Details

I. General information

NPI: 1790640324
Provider Name (Legal Business Name): MALIA COLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14605 GRAHAM AVE
VICTORVILLE CA
92394-7004
US

IV. Provider business mailing address

20988 QUILEUTE RD
APPLE VALLEY CA
92308-6434
US

V. Phone/Fax

Practice location:
  • Phone: 760-843-9319
  • Fax:
Mailing address:
  • Phone: 909-830-3988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: