Provider Demographics
NPI:1801951314
Name:MALLADA, MARIA L (RN)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:L
Last Name:MALLADA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 W TRENTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-3719
Mailing Address - Country:US
Mailing Address - Phone:559-323-9833
Mailing Address - Fax:
Practice Address - Street 1:342 W TRENTON AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-3719
Practice Address - Country:US
Practice Address - Phone:559-323-9833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA488507163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health