Provider Demographics
NPI:1760827646
Name:MALLA, RISHIKESH (MD)
Entity Type:Individual
Prefix:DR
First Name:RISHIKESH
Middle Name:
Last Name:MALLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RISHI
Other - Middle Name:
Other - Last Name:MALLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:21515 HAWTHORNE BLVD # GL-100
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-6501
Mailing Address - Country:US
Mailing Address - Phone:424-571-2618
Mailing Address - Fax:
Practice Address - Street 1:21515 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-6501
Practice Address - Country:US
Practice Address - Phone:424-571-2618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2020-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1321482084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry