Provider Demographics
NPI:1629019930
Name:MALLEY, NATALYA G (MD)
Entity Type:Individual
Prefix:MS
First Name:NATALYA
Middle Name:G
Last Name:MALLEY
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:PO BOX 28949
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-8949
Mailing Address - Country:US
Mailing Address - Phone:559-228-4200
Mailing Address - Fax:559-224-3920
Practice Address - Street 1:7355 N PALM AVE STE 100
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-5770
Practice Address - Country:US
Practice Address - Phone:559-271-6300
Practice Address - Fax:559-271-6326
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52534207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110119991OtherMEDICARE RR
CA00A525340Medicaid
110119991OtherMEDICARE RR
F98855Medicare UPIN