Healthcare Provider Details

I. General information

NPI: 1215497854
Provider Name (Legal Business Name): ADIL AMIR MALIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 NE 129TH ST
VANCOUVER WA
98686-3236
US

IV. Provider business mailing address

13855 E 14TH ST
SAN LEANDRO CA
94578-2611
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-3142
  • Fax: 360-514-6809
Mailing address:
  • Phone: 510-357-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA201925
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD61519934
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA201925
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: