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General NPI Number Information
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NPI Number | 1760010276
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Entity Type | Individual
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Provider Name | MALTISH LORENZO
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Gender | Male
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Dates
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Enumeration Date | 03/30/2020
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Last Update Date | 08/06/2024
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Provider Practice Location Address
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Address Line | 2925 PALO VERDE AVE
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City | LONG BEACH
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State | CA
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Zip | 90815-1552
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Country | US
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Telephone | 562-799-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 4739 SAWTELLE BLVD
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City | CULVER CITY
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State | CA
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Zip | 90230-4834
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Country | US
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Telephone | 661-480-8357
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Fax |
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | A189134
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License Number State | CA
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