Healthcare Provider Details

I. General information

NPI: 1154827913
Provider Name (Legal Business Name): JANYNE LANDRA MALLENDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 E MCDOWELL RD
PHOENIX AZ
85006-2506
US

IV. Provider business mailing address

755 E MCDOWELL RD
PHOENIX AZ
85006-2506
US

V. Phone/Fax

Practice location:
  • Phone: 480-733-7448
  • Fax:
Mailing address:
  • Phone: 480-733-7448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number12544
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number12544
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: