NPIMap

Organization Active NPI

Jerry B Malleus, DDS Inc.

  • Dentist
  • San Fernando, CA
National Provider Identifier
1922498302
Registry record updated Jan 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
24826 Issued in CA
Legal business name
JERRY B MALLEUS, DDS INC.
Practice address
125 S Brand Blvd
San Fernando, CA 91340-3304
Phone
(818) 365-6321
Fax
(818) 365-0011
NPI assigned
Jan 23, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jerry B Malleus, DDS
Title
Pres.
Phone
(818) 832-5102

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 24826 CA Primary

Addresses

Primary practice location

125 S Brand Blvd
San Fernando, CA 91340-3304

Mailing address

125 S Brand Blvd
San Fernando, CA 91340-3304
Phone (818) 365-6321

National Provider Directory

National Provider Directory
Tax ID family
Dr Jerry B Malleus2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1421971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421971200000",
    "number": "1922498302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 S BRAND BLVD",
            "city": "SAN FERNANDO",
            "state": "CA",
            "postal_code": "913403304",
            "telephone_number": "818-365-6321",
            "fax_number": "818-365-0011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 S BRAND BLVD",
            "city": "SAN FERNANDO",
            "state": "CA",
            "postal_code": "913403304",
            "telephone_number": "818-365-6321",
            "fax_number": "818-365-0011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY B MALLEUS, DDS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-23",
        "last_updated": "2015-01-23",
        "status": "A",
        "authorized_official_last_name": "MALLEUS",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRES.",
        "authorized_official_telephone_number": "818-832-5102",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "24826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Fernando, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.