Provider Demographics
NPI:1720142581
Name:MALINOWSKI, MARY ELLEN (CPNP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELLEN
Last Name:MALINOWSKI
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:333 ORANGE AVE UNIT 5
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-1425
Mailing Address - Country:US
Mailing Address - Phone:619-437-0553
Mailing Address - Fax:
Practice Address - Street 1:34520 BOB WILSON DR STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-2100
Practice Address - Country:US
Practice Address - Phone:619-532-7108
Practice Address - Fax:619-532-7721
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP9503363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics