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General NPI Number Information
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NPI Number | 1154396661
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Entity Type | Individual
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Provider Name | CHRISTOPHER ALFONSO MALLARI PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/19/2006
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 13782 PLANTATION RD BUILDING 4, SUITE 201
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City | FORT MYERS
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State | FL
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Zip | 33912-4462
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Country | US
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Telephone | 239-343-1105
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Fax | 239-343-1106
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Provider Business Mailing Address
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Address Line | 8791 CONFERENCE DR STE 100
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City | FORT MYERS
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State | FL
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Zip | 33919-5822
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Country | US
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Telephone | 239-344-9327
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Fax | 239-247-9327
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9103134
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License Number State | FL
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