Healthcare Provider Details

I. General information

NPI: 1154353969
Provider Name (Legal Business Name): DARREN JAY MALINOSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3011
US

IV. Provider business mailing address

1400 SW 5TH AVE FL 5
PORTLAND OR
97201-5509
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-8311
  • Fax:
Mailing address:
  • Phone: 503-494-8311
  • Fax: 714-456-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberA91553
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: