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General NPI Number Information
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NPI Number | 1205021045
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Entity Type | Organization
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Legal Business Name | PERRY MALOFF, M.D., A MEDICAL CORP
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 09/13/2007
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Provider Practice Location Address
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Address Line | 100 S CITRUS AVE SUITE 206
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City | COVINA
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State | CA
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Zip | 91723-2653
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Country | US
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Telephone | 626-915-7581
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Fax | 626-915-7588
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Provider Business Mailing Address
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Address Line | 100 S CITRUS AVE SUITE 206
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City | COVINA
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State | CA
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Zip | 91723-2653
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Country | US
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Telephone | 626-915-7581
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Fax | 626-915-7588
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PERRY A MALOFF
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Credential | M.D.
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Telephone | 626-915-7581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | G40885
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License Number State | CA
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