Provider Demographics
NPI:1679364210
Name:MALLEA, DENISE
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:MALLEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:
Other - Last Name:MALLEA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PRSS
Mailing Address - Street 1:5151 MAPLE AVE # 4-D
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-8136
Mailing Address - Country:US
Mailing Address - Phone:214-645-7162
Mailing Address - Fax:
Practice Address - Street 1:5151 MAPLE AVE # 4-D
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-8136
Practice Address - Country:US
Practice Address - Phone:214-645-7162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist