=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700921426
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NAJLA ELIAS MALAK-MAJDALANI O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 64 AUTUMNWIND CT
-----------------------------------------------------
City | SAN RAMON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94583-5310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-328-1015
-----------------------------------------------------
Fax | 510-784-0433
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 64 AUTUMNWIND CT.
-----------------------------------------------------
City | SAN RAMON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94583
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-328-1015
-----------------------------------------------------
Fax | 510-784-0433
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 9424T
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------