Healthcare Provider Details

I. General information

NPI: 1003000712
Provider Name (Legal Business Name): SHEILA ORALLO MALLORY N. P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 11/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1867 E FIR AVE STE 104
FRESNO CA
93720-3841
US

IV. Provider business mailing address

1867 E FIR AVE STE 104
FRESNO CA
93720-3841
US

V. Phone/Fax

Practice location:
  • Phone: 559-325-5876
  • Fax: 559-325-5838
Mailing address:
  • Phone: 559-325-5876
  • Fax: 559-325-5838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11495
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: