Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 11495 | CA |
NPI | 1003000712 |
---|---|
Provider Name | Ms. Sheila Orallo Mallory |
First Address | Fresno, CA 93720-3841 |
Second Address | Fresno, CA 93720-3841 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2007 |
Last Update Date | 19/11/2008 |