MEDICARE: ALAN ELIE MALKI M.D.

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	174400000X	Specialist	G43969	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	ZZZ13778Z	OTHER	CA	MEDICARE PIN
4	00G439692	OTHER	CA	MEDICARE INDIVIDUAL PTAN
5	ZZZ13779Z	OTHER		MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942231998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN ELIE MALKI M.D.

Provider Business Mailing Address
First Line	:	700 E REDLANDS BLVD
Second Line	:	U515
City	:	REDLANDS
State	:	CA
Zip	:	92373-6109
Country	:	US
Telephone Number	:	805-687-3744
Fax Number	:	805-687-6048

Provider Business Practice Location Address
First Line	:	2415 BATH ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-4324
Country	:	US
Telephone Number	:	805-687-3744
Fax Number	:	805-687-6048

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	09/11/2016

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Directions to “ ALAN ELIE MALKI M.D.” Practice Location

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