Healthcare Provider Details

I. General information

NPI: 1447497219
Provider Name (Legal Business Name): FATIMA T MALIK M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 04/26/2022
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 BEVERLY BLVD # 250
WEST HOLLYWOOD CA
90048-2438
US

IV. Provider business mailing address

4140 W 190TH ST
TORRANCE CA
90504-5513
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-2641
  • Fax: 310-423-4678
Mailing address:
  • Phone: 310-967-1780
  • Fax: 866-991-4287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number42266
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number42266
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberC135655
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: