MEDICARE: DEETI MALI

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	292479	CA

General Provider Information

NPI Number	:	1881065753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEETI MALI

Provider Business Mailing Address
First Line	:	165 CALIFORNIA ST APT 2
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91006-3650
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	774 S PLACENTIA AVE STE 200
Second Line	:
City	:	PLACENTIA
State	:	CA
Zip	:	92870-6838
Country	:	US
Telephone Number	:	800-870-7989
Fax Number	:	714-646-8321

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2015
Last Update Date	:	06/30/2023

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Directions to “ DEETI MALI ” Practice Location

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