Healthcare Provider Details

I. General information

NPI: 1821096009
Provider Name (Legal Business Name): OURANIA B MALLIRIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7554 15TH AVE NW
SEATTLE WA
98117-5409
US

IV. Provider business mailing address

7554 15TH AVE NW
SEATTLE WA
98117-5409
US

V. Phone/Fax

Practice location:
  • Phone: 203-783-9300
  • Fax: 206-789-8404
Mailing address:
  • Phone: 203-783-9300
  • Fax: 206-789-8404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00017659
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: