Provider Demographics
NPI:1477844793
Name:MALHOTRA, LAVINA (MD)
Entity Type:Individual
Prefix:DR
First Name:LAVINA
Middle Name:
Last Name:MALHOTRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 LA CASA VIA
Mailing Address - Street 2:STE 211
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3046
Mailing Address - Country:US
Mailing Address - Phone:614-293-8704
Mailing Address - Fax:614-293-4063
Practice Address - Street 1:395 W 12TH AVE RM 654
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1267
Practice Address - Country:US
Practice Address - Phone:614-293-8704
Practice Address - Fax:614-293-4063
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA138713193400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes193400000XGroupSingle Specialty