Provider Demographics
NPI:1518032218
Name:MALAMUD, ARIEL (MD)
Entity type:Individual
Prefix:
First Name:ARIEL
Middle Name:
Last Name:MALAMUD
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 1:1513 S GRAND AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3070
Mailing Address - Country:US
Mailing Address - Phone:213-440-2040
Mailing Address - Fax:213-234-4516
Practice Address - Street 1:1513 S GRAND AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3070
Practice Address - Country:US
Practice Address - Phone:213-440-2040
Practice Address - Fax:213-234-4516
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75407207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA75407DMedicare PIN
A24894Medicare UPIN
CA00A754070Medicaid