Provider Demographics
NPI:1962536581
Name:GEORGE J. MALOOF, JR., M.D., INC.
Entity type:Organization
Organization Name:GEORGE J. MALOOF, JR., M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MALOOF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-352-3555
Mailing Address - Street 1:1420 OCOTILLO DR STE A
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4213
Mailing Address - Country:US
Mailing Address - Phone:760-352-3555
Mailing Address - Fax:760-352-7094
Practice Address - Street 1:1420 OCOTILLO DR STE A
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4213
Practice Address - Country:US
Practice Address - Phone:760-352-3555
Practice Address - Fax:760-352-7094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43052207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A430520Medicaid
E01669Medicare UPIN
CA00A430520Medicaid