Healthcare Provider Details

I. General information

NPI: 1134296387
Provider Name (Legal Business Name): PETER REEVES MALLEN M.D., FRCS(C), FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11606 HARRINGTON ST
BAKERSFIELD CA
93311-9273
US

IV. Provider business mailing address

11606 HARRINGTON ST
BAKERSFIELD CA
93311-9273
US

V. Phone/Fax

Practice location:
  • Phone: 661-665-2363
  • Fax: 661-663-7657
Mailing address:
  • Phone: 661-665-2363
  • Fax: 661-663-7657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberCA28610
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: