MEDICARE: SHAUGN MALLARI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	298016	CA

General Provider Information

NPI Number	:	1295203339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUGN MALLARI

Provider Business Mailing Address
First Line	:	1475 ISLAND AVE
Second Line	:	UNIT 2403
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-8244
Country	:	US
Telephone Number	:	818-438-5991
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 W PARMER LN STE E
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78727-4657
Country	:	US
Telephone Number	:	512-670-3238
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2018
Last Update Date	:	04/27/2022

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Directions to “ SHAUGN MALLARI ” Practice Location

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