Provider Demographics
NPI:1164708582
Name:NAVIN MALLAVARAM, M.D., INC.
Entity Type:Organization
Organization Name:NAVIN MALLAVARAM, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLAVARAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-469-9120
Mailing Address - Street 1:5924 STONERIDGE DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-2887
Mailing Address - Country:US
Mailing Address - Phone:925-469-9120
Mailing Address - Fax:
Practice Address - Street 1:5924 STONERIDGE DR
Practice Address - Street 2:SUITE 206
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2887
Practice Address - Country:US
Practice Address - Phone:925-469-9120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104871208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty