Provider Demographics
NPI:1538228234
Name:MALUSO, TINA (NP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:MALUSO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:MALUSO BOLTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:9201 W SUNSET BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-3704
Mailing Address - Country:US
Mailing Address - Phone:310-623-1222
Mailing Address - Fax:310-623-1122
Practice Address - Street 1:9201 W SUNSET BLVD STE 310
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-3704
Practice Address - Country:US
Practice Address - Phone:310-623-1222
Practice Address - Fax:310-623-1122
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11883363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner