Healthcare Provider Details

I. General information

NPI: 1760229876
Provider Name (Legal Business Name): CHERYLL MARIE MALLARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 SILVER CREEK VALLEY PLACE
SAN JOSE CA
95138
US

IV. Provider business mailing address

5855 SILVER CREEK VALLEY PLACE
SAN JOSE CA
95138
US

V. Phone/Fax

Practice location:
  • Phone: 408-574-9254
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number95346275
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: