=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811490667
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RANDY V. MALLARI PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2018
-----------------------------------------------------
Last Update Date | 04/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16220 N SCOTTSDALE RD STE 300
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85254-1798
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-295-9977
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14655 N 35TH DR
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85053-4605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RANDY V. MALLARI
-----------------------------------------------------
Credential | PMHNP-BC, FNP-BC
-----------------------------------------------------
Telephone | 602-908-8580
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------