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General NPI Number Information
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NPI Number | 1568771210
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Entity Type | Organization
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Legal Business Name | SEYMOUR MALLIS, M.D., P.C.
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Dates
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Enumeration Date | 09/29/2010
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Last Update Date | 09/29/2010
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Provider Practice Location Address
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Address Line | 7339 EL CAJON BLVD SUITE H
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City | LA MESA
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State | CA
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Zip | 91942-7435
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Country | US
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Telephone | 619-668-1515
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Fax | 619-668-1525
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Provider Business Mailing Address
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Address Line | 7339 EL CAJON BLVD SUITE H
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City | LA MESA
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State | CA
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Zip | 91942-7435
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Country | US
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Telephone | 619-668-1515
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Fax | 619-668-1525
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SEYMOUR MALLIS
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Credential | M.D.
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Telephone | 619-668-1515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A23608
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License Number State | CA
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