Organization
DOMINIQUE MALL,MD,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOMINIQUE LUCIENNE MALL MD (PRESIDENT)
(310) 902-8947
Entity
Organization
Contact information
Practice address
13911 OLD HARBOR LN, #306, MARINA DEL REY, CA 90292-7395
(310) 577-9547
(310) 577-9547
Mailing address
13911 OLD HARBOR LN, #306, MARINA DEL REY, CA 90292-7395
(310) 577-9547
(310) 577-9547
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Enumeration date
01/23/2007
Last updated
08/24/2011
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