Provider Demographics
NPI:1447491857
Name:JEREMIAH J MALONEY, D.O.
Entity type:Organization
Organization Name:JEREMIAH J MALONEY, D.O.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MALONEY
Authorized Official - Suffix:V
Authorized Official - Credentials:DO
Authorized Official - Phone:951-591-1840
Mailing Address - Street 1:41327 CRESTA VERDE CT
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-4403
Mailing Address - Country:US
Mailing Address - Phone:951-591-1840
Mailing Address - Fax:
Practice Address - Street 1:25150 HANCOCK AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5987
Practice Address - Country:US
Practice Address - Phone:951-698-8805
Practice Address - Fax:951-698-8898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8468207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty