Healthcare Provider Details

I. General information

NPI: 1306198429
Provider Name (Legal Business Name): RANDY V. MALLARI PMHNP-BC/C, FNP-BC/C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2012
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10901 E MCDOWELL RD
SCOTTSDALE AZ
85256-5300
US

IV. Provider business mailing address

10250 N 124TH ST
SCOTTSDALE AZ
85259-5201
US

V. Phone/Fax

Practice location:
  • Phone: 480-278-7742
  • Fax:
Mailing address:
  • Phone: 480-295-9977
  • Fax: 602-391-2484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95034292
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-5050
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number321587
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number873430
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10041249
License Number StateOR
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number83016
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: