Provider Demographics
NPI:1699167098
Name:JOSEPH MALANCHARUVIL, PH.D.,A PSYCH CORPORATION
Entity type:Organization
Organization Name:JOSEPH MALANCHARUVIL, PH.D.,A PSYCH CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:MALANCHARUVIL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, ABPP
Authorized Official - Phone:951-347-3765
Mailing Address - Street 1:2048 N WATERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-4835
Mailing Address - Country:US
Mailing Address - Phone:951-347-3765
Mailing Address - Fax:909-881-3765
Practice Address - Street 1:2048 N WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4835
Practice Address - Country:US
Practice Address - Phone:951-347-3765
Practice Address - Fax:909-881-3765
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSEPH MALANCHARUVIL, PH.D.,A PSYCH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8026251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health