Healthcare Provider Details

I. General information

NPI: 1710329396
Provider Name (Legal Business Name): LORENC MALELLARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 SAN DIMAS ST B231
BAKERSFIELD CA
93301-1494
US

IV. Provider business mailing address

3838 SAN DIMAS ST B231
BAKERSFIELD CA
93301-1494
US

V. Phone/Fax

Practice location:
  • Phone: 661-716-7100
  • Fax: 661-716-5484
Mailing address:
  • Phone: 661-716-7100
  • Fax: 661-716-5484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA129942
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberA129942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: