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General NPI Number Information
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NPI Number | 1164708582
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Entity Type | Organization
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Legal Business Name | NAVIN MALLAVARAM, M.D., INC.
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Dates
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Enumeration Date | 10/31/2011
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Last Update Date | 12/11/2013
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Provider Practice Location Address
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Address Line | 5924 STONERIDGE DR SUITE 206
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City | PLEASANTON
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State | CA
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Zip | 94588-2887
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Country | US
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Telephone | 925-469-9120
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Fax |
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Provider Business Mailing Address
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Address Line | 5924 STONERIDGE DR SUITE 206
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City | PLEASANTON
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State | CA
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Zip | 94588-2887
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Country | US
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Telephone | 925-469-9120
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NAVIN MALLAVARAM
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Credential | M.D.
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Telephone | 925-469-9120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | A104871
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License Number State | CA
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