Healthcare Provider Details

I. General information

NPI: 1023676376
Provider Name (Legal Business Name): JOSEPH MAHALLI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2019
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1759 W AVENUE J STE 101
LANCASTER CA
93534-2703
US

IV. Provider business mailing address

PO BOX 2768
LANCASTER CA
93539-2768
US

V. Phone/Fax

Practice location:
  • Phone: 661-948-1388
  • Fax: 661-948-1223
Mailing address:
  • Phone: 661-948-1388
  • Fax: 661-948-1223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number20A19937
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: