Provider Demographics
NPI:1275834277
Name:MALLEY, LORRIE ROBIN (RDHAP)
Entity Type:Individual
Prefix:
First Name:LORRIE
Middle Name:ROBIN
Last Name:MALLEY
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 AVERITT ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-5236
Mailing Address - Country:US
Mailing Address - Phone:831-427-0799
Mailing Address - Fax:
Practice Address - Street 1:128 AVERITT ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-5236
Practice Address - Country:US
Practice Address - Phone:831-427-0799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-06
Last Update Date:2010-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA285124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist