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General NPI Number Information
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NPI Number | 1659153195
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Entity Type | Organization
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Legal Business Name | GMC HEALTHCARE PLLC
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Dates
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Enumeration Date | 10/19/2023
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 10250 N 124TH ST
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City | SCOTTSDALE
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State | AZ
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Zip | 85259-5201
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Country | US
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Telephone | 602-603-4660
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Fax | 602-860-6050
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Provider Business Mailing Address
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Address Line | 10250 N 124TH ST
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City | SCOTTSDALE
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State | AZ
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Zip | 85259-5201
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Country | US
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Telephone | 602-603-4660
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Fax | 602-860-6050
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Authorized Official
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Title or Position | ADMINISTRATOR/ PROVIDER
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Name | RANDY V. MALLARI
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Credential | PMHNP-BC, FNP-BC
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Telephone | 602-908-8580
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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