Individual
ANN MARIE MALLAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3200 KEARNEY ST., FREMONT, CA 94538-2299
(510) 490-1222
Mailing address
325 DISTEL CIR, LOS ALTOS, CA 94022-1408
(510) 490-1222
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G80264
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G802640
—
CA
Enumeration date
07/07/2006
Last updated
05/29/2020
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