Individual
ANDREA C MALLET-REECE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G46476
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G464760
RENDERING NUMBER
—
01
—
W8705E
GROUP PTAN
CA
01
—
WG46476H
INDIVIDUAL PTAN
CA
Enumeration date
06/28/2006
Last updated
12/18/2007
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