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General NPI Number Information
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NPI Number | 1487965950
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Entity Type | Organization
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Legal Business Name | NUSRAT N MALIK MD INC
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Dates
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Enumeration Date | 06/29/2010
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Last Update Date | 07/01/2010
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Provider Practice Location Address
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Address Line | 1501 CLAUS RD
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City | MODESTO
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State | CA
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Zip | 95355-9711
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Country | US
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Telephone | 209-575-4575
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Fax | 209-575-4598
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Provider Business Mailing Address
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Address Line | 3113 JOLIE PRE CIR
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City | MODESTO
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State | CA
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Zip | 95356-9315
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Country | US
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Telephone | 209-575-4575
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Fax | 209-575-4598
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Authorized Official
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Title or Position | PRESIDENT
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Name | NUSRAT N MALIK
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Credential | MD
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Telephone | 209-575-4575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 54022
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License Number State | CA
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