| Organization Name: | MALIBU MEDICAL CORP |
| NPI Number: | 1386988590 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LISA M BENYA (OWNER) |
| Mailing Address: | 23661 Pacific Coast Hwy Malibu |
| State: | CA US |
| Postal Code: | 902654825 |
| Phone Number: | 3104561603 |
| Fax Number: | 3104565697 |
| NPI Enumeration Date: | 11/15/2012 |
| NPI Last Update Date: | 11/15/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | 20A7615 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |