Provider Demographics
NPI:1033265301
Name:MALOFF, PERRY A (MD)
Entity type:Individual
Prefix:
First Name:PERRY
Middle Name:A
Last Name:MALOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S CITRUS AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-2653
Mailing Address - Country:US
Mailing Address - Phone:626-915-7581
Mailing Address - Fax:626-915-7588
Practice Address - Street 1:100 S CITRUS AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-2653
Practice Address - Country:US
Practice Address - Phone:626-915-7581
Practice Address - Fax:626-915-7588
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40885174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA48387Medicare UPIN
CAW7902Medicare ID - Type Unspecified