Provider Information for 1881149599
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JARED MALONEY
Sex: Male
NPI: 1881149599
Last Updated: 2017-10-24
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1881149599 | ||||||||||||
| Enumeration Date | 2016-08-23 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 2275 ARLINGTON DR SAN LEANDRO, CA 94578-1132 United States Phone: 510-317-1444 | Fax: | ||||||||||||
| Primary Practice Address | 2275 ARLINGTON DR SAN LEANDRO, CA 94578-1132 United States Phone: 510-317-1444 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 2501 HARRISON ST | ||||||||||||
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