MEDICARE: MALAMA MEDICAL GROUP CA PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	374J00000X	Doula
2	133VN1201X	Obesity and Weight Management Nutrition Registered Dietitian
3	174H00000X	Health Educator
4	1041C0700X	Clinical Social Worker
5	172V00000X	Community Health Worker
6	133N00000X	Nutritionist
7	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1851169155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MALAMA MEDICAL GROUP CA PC

Provider Business Mailing Address
First Line	:	303 TWIN DOLPHIN DR FL 6
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94065-1497
Country	:	US
Telephone Number	:	408-256-3180
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 TWIN DOLPHIN DR FL 6
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94065-1497
Country	:	US
Telephone Number	:	949-424-5479
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	PRIYANKA K WALI
Credential	:	MD
Telephone Number	:	408-256-3180

Provider Enumeration Date	:	12/15/2023
Last Update Date	:	06/04/2026

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