Provider Demographics
NPI:1598781171
Name:MALLIA, RICHARD SANTO (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SANTO
Last Name:MALLIA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16812 NW 73RD CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4114
Mailing Address - Country:US
Mailing Address - Phone:305-632-9975
Mailing Address - Fax:305-823-3085
Practice Address - Street 1:16812 NW 73RD CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-4114
Practice Address - Country:US
Practice Address - Phone:305-632-9975
Practice Address - Fax:305-823-3085
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2953213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340242800Medicaid
FL340242800Medicaid
FLE6020Medicare PIN