Individual
DR. MALLORY CHAVANNES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4650 W SUNSET BLVD # 78, LOS ANGELES, CA 90027-6062
(438) 395-1651
Mailing address
4650 W SUNSET BLVD # 78, LOS ANGELES, CA 90027-6062
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
A153763
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A153763
—
CA
Enumeration date
02/05/2018
Last updated
02/05/2018
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