Individual
JUSTIN ELI MALLIT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
855 E MADISON AVE, EL CAJON, CA 92020-3819
(619) 440-2751
Mailing address
425 N DATE ST, ESCONDIDO, CA 92025-3413
(760) 737-6960
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA22408
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W14158
GROUP PTAN
CA
Enumeration date
07/23/2012
Last updated
09/26/2023
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