Individual
MRS. JENNIFER REBECCA MALLOY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2255 S BASCOM AVE, SUITE 200, CAMPBELL, CA 95008-7800
(408) 376-3626
(408) 871-2377
Mailing address
2255 S BASCOM AVE, SUITE 200, CAMPBELL, CA 95008-7800
(408) 376-3626
(408) 871-2377
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA17849
CA
Other
Enumeration date
10/18/2006
Last updated
02/26/2010
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