Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | G73041 | CA |
NPI | 1013084995 |
---|---|
Provider Name | Jeffrey S. Mallin |
First Address | Bellflower, CA 90706-2246 |
Second Address | Bellflower, CA 90706-2246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 29/11/2021 |