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General NPI Number Information
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NPI Number | 1932524485
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Entity Type | Organization
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Legal Business Name | LITOS O. MALLARE, M.D., INC.
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Dates
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Enumeration Date | 02/20/2014
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Last Update Date | 06/15/2015
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Provider Practice Location Address
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Address Line | 23823 MALIBU RD SUITE 50, #189
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City | MALIBU
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State | CA
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Zip | 90265-4628
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Country | US
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Telephone | 310-650-8951
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Fax | 310-457-1082
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Provider Business Mailing Address
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Address Line | 23823 MALIBU RD SUITE 50, #189
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City | MALIBU
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State | CA
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Zip | 90265-4628
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Country | US
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Telephone | 310-650-8951
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Fax | 310-457-1082
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. LITOS O. MALLARE
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Credential | M.D.
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Telephone | 310-650-8951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A69317
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License Number State | CA
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