MEDICARE: MELLANI MALLARI LARA LVN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	197993	CA

General Provider Information

NPI Number	:	1467578047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELLANI MALLARI LARA LVN

Provider Business Mailing Address
First Line	:	53941 CALLE SANBORN
Second Line	:
City	:	COACHELLA
State	:	CA
Zip	:	92236-3139
Country	:	US
Telephone Number	:	760-218-0196
Fax Number	:

Provider Business Practice Location Address
First Line	:	81557 DR CARREON BLVD STE C9
Second Line	:
City	:	INDIO
State	:	CA
Zip	:	92201-5562
Country	:	US
Telephone Number	:	760-391-6999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	02/05/2019

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