Healthcare Provider Details

I. General information

NPI: 1992787238
Provider Name (Legal Business Name): MICHAEL D MALONEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 01/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 BRUCE ST
YREKA CA
96097-3450
US

IV. Provider business mailing address

PO BOX 1105
YREKA CA
96097-1105
US

V. Phone/Fax

Practice location:
  • Phone: 530-842-4121
  • Fax: 530-842-9054
Mailing address:
  • Phone: 530-842-4121
  • Fax: 530-842-9054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG46471
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: