Provider Demographics
NPI:1659100675
Name:MALLORY, MA JINKY HECHANOVA (RN)
Entity type:Individual
Prefix:
First Name:MA JINKY
Middle Name:HECHANOVA
Last Name:MALLORY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MA JINKY
Other - Middle Name:HECHANOVA
Other - Last Name:MALLORY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:435 TEPATITLAN CT
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3164
Mailing Address - Country:US
Mailing Address - Phone:442-270-5333
Mailing Address - Fax:
Practice Address - Street 1:435 TEPATITLAN CT
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3164
Practice Address - Country:US
Practice Address - Phone:442-270-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95371916163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse