Healthcare Provider Details

I. General information

NPI: 1295826378
Provider Name (Legal Business Name): KATHRINE H MALOZZI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRINE L HERON

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5870 ALUMNI CIR
MOBILE AL
36688-0002
US

IV. Provider business mailing address

5870 ALUMNI CIR
MOBILE AL
36688-0002
US

V. Phone/Fax

Practice location:
  • Phone: 251-460-7151
  • Fax: 251-414-8227
Mailing address:
  • Phone: 251-460-7151
  • Fax: 251-414-8227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39020000X
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO992
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: