Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | PO2953 | FL |
NPI | 1598781171 |
---|---|
Provider Name | Dr. Richard Santo Mallia |
First Address | Hialeah, FL 33015-4114 |
Second Address | Hialeah, FL 33015-4114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 11/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
340242800 | (05) | FL |
U87284 | (02) | FL |