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General NPI Number Information
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NPI Number | 1740773530
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Entity Type | Individual
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Provider Name | MALIA DADSETAN DO
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Gender | Female
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Dates
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Enumeration Date | 06/07/2018
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Last Update Date | 11/14/2023
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Provider Practice Location Address
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Address Line | 17251 17TH ST STE B
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City | TUSTIN
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State | CA
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Zip | 92780-1963
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Country | US
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Telephone | 657-241-8580
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Fax | 714-665-4608
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Provider Business Mailing Address
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Address Line | 17251 17TH ST STE B
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City | TUSTIN
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State | CA
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Zip | 92780-1963
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Country | US
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Telephone | 657-241-8580
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Fax | 714-665-4608
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D4475110
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License Number State | CA
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