Healthcare Provider Details

I. General information

NPI: 1942147798
Provider Name (Legal Business Name): ROLAND JOHN C MALLARI PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17220 NEWHOPE ST STE 120
FOUNTAIN VALLEY CA
92708-4283
US

IV. Provider business mailing address

6450 SAVOY CIR
BUENA PARK CA
90621-2614
US

V. Phone/Fax

Practice location:
  • Phone: 714-232-2125
  • Fax:
Mailing address:
  • Phone: 714-232-2125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number309924
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: