Healthcare Provider Details

I. General information

NPI: 1619464682
Provider Name (Legal Business Name): NEOMAL MUTHUMALA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 MONTE VISTA AVE STE 190
CLAREMONT CA
91711-6600
US

IV. Provider business mailing address

1601 MONTE VISTA AVE STE 260
CLAREMONT CA
91711-6604
US

V. Phone/Fax

Practice location:
  • Phone: 909-865-9977
  • Fax: 909-469-2119
Mailing address:
  • Phone: 909-865-9501
  • Fax: 909-469-2146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A19087
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: