Individual
SAMANTHA MALM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2500 MILVIA ST, BERKELEY, CA 94704
(510) 204-5600
(510) 204-5462
Mailing address
325 DISTEL CIR, LOS ALTOS, CA 94022-1408
(510) 204-5600
(510) 204-5462
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
A89453
CA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
A89453
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A89453
STATE MEDICAL LICENSE
CA
Enumeration date
01/10/2006
Last updated
08/05/2024
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