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General NPI Number Information
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NPI Number | 1093238545
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Entity Type | Organization
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Legal Business Name | MALLORY HILL
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Dates
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Enumeration Date | 07/17/2017
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Last Update Date | 07/17/2017
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Provider Practice Location Address
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Address Line | 350 LAKE VIEW
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City | TAHOMA
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State | CA
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Zip | 96142
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Country | US
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Telephone | 949-371-3573
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Fax |
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Provider Business Mailing Address
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Address Line | 668 N COAST HWY # 1112
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-1513
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Country | US
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Telephone | 949-371-3573
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MALLORY P HILL
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Credential |
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Telephone | 949-371-3573
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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