Provider Demographics
NPI:1104263540
Name:MALIS, IRVING (MD)
Entity type:Individual
Prefix:DR
First Name:IRVING
Middle Name:
Last Name:MALIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23312 PARK HACIENDA
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1715
Mailing Address - Country:US
Mailing Address - Phone:818-426-8700
Mailing Address - Fax:267-629-7055
Practice Address - Street 1:23312 PARK HACIENDA
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1715
Practice Address - Country:US
Practice Address - Phone:818-426-8700
Practice Address - Fax:267-629-7055
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA21089207QA0505X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine