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General NPI Number Information
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NPI Number | 1982496501
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Entity Type | Individual
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Provider Name | MR. ELI FRANK MALL
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Gender | Male
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Dates
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Enumeration Date | 05/20/2025
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 1 QUALITY DR
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City | VACAVILLE
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State | CA
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Zip | 95688-9494
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Country | US
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Telephone | 707-624-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 411 22ND ST APT 1
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City | SACRAMENTO
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State | CA
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Zip | 95816-3054
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Country | US
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Telephone | 916-475-8340
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 130097
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License Number State | CA
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