MEDICARE: MISS DOROTHY DAWN MALSACK R.D.N.

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	133V00000X	Registered Dietitian	870637	CA

General Provider Information

NPI Number	:	1952959207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DOROTHY DAWN MALSACK R.D.N.

Provider Business Mailing Address
First Line	:	281 ESPLANADE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92612
Country	:	US
Telephone Number	:	310-993-1197
Fax Number	:

Provider Business Practice Location Address
First Line	:	2405 ATLANTIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-3221
Country	:	US
Telephone Number	:	949-371-6947
Fax Number	:	313-668-6888

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

Provider Enumeration Date	:	08/29/2019
Last Update Date	:	01/27/2026

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