Provider Demographics
NPI:1215080932
Name:MALKA, DEBORAH (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:MALKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108B CAMINO DEL CANON
Mailing Address - Street 2:
Mailing Address - City:CUNDIYO
Mailing Address - State:NM
Mailing Address - Zip Code:87522-9449
Mailing Address - Country:US
Mailing Address - Phone:505-351-9925
Mailing Address - Fax:
Practice Address - Street 1:108B CAMINO DEL CANON
Practice Address - Street 2:
Practice Address - City:CUNDIYO
Practice Address - State:NM
Practice Address - Zip Code:87522-9449
Practice Address - Country:US
Practice Address - Phone:505-351-9925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2022-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM92-291208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG750860OtherLICENSE
CAF69467Medicare UPIN
CA00G750860Medicare ID - Type Unspecified