1932360427 NPI number — ZACHARY MALLON MD

Table of content: ZACHARY MALLON MD (NPI 1932360427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932360427 NPI number — ZACHARY MALLON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALLON
Provider First Name:
ZACHARY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932360427
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6620 COYLE AVE
Provider Second Line Business Mailing Address:
SUITE 212
Provider Business Mailing Address City Name:
CARMICHAEL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95608-6333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-536-9455
Provider Business Mailing Address Fax Number:
916-536-9424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 QUALITY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VACAVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95688-9494
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-624-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/18/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207XX0801X , with the licence number:  A109177 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3972360427 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".