Provider Demographics
NPI:1053812628
Name:MALKAWI, RAZAN (SLPA)
Entity type:Individual
Prefix:
First Name:RAZAN
Middle Name:
Last Name:MALKAWI
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8228 E BLACKWILLOW CIR
Mailing Address - Street 2:210
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1979
Mailing Address - Country:US
Mailing Address - Phone:714-280-7037
Mailing Address - Fax:
Practice Address - Street 1:140 S CHAPARRAL CT
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-2239
Practice Address - Country:US
Practice Address - Phone:714-282-8852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47232355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4723OtherSLPAHADB