MEDICARE: LITOS O. MALLARE, M.D., INC.

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	2084P0800X	Psychiatry Physician	A69317	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932524485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITOS O. MALLARE, M.D., INC.

Provider Business Mailing Address
First Line	:	23823 MALIBU RD
Second Line	:	SUITE 50, #189
City	:	MALIBU
State	:	CA
Zip	:	90265-4628
Country	:	US
Telephone Number	:	310-650-8951
Fax Number	:	310-457-1082

Provider Business Practice Location Address
First Line	:	23823 MALIBU RD
Second Line	:	SUITE 50, #189
City	:	MALIBU
State	:	CA
Zip	:	90265-4628
Country	:	US
Telephone Number	:	310-650-8951
Fax Number	:	310-457-1082

Authorized Official
Title or Position	:	PSYCHIATRIST
Name	:	DR. LITOS O. MALLARE
Credential	:	M.D.
Telephone Number	:	310-650-8951

Provider Enumeration Date	:	02/20/2014
Last Update Date	:	06/15/2015

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Directions to “LITOS O. MALLARE, M.D., INC. ” Practice Location

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