Individual
DR. JAYA PRAKASH MALLELA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1323 W 6TH AVE, STILLWATER, OK 74074-4306
(405) 372-1480
Mailing address
4700 KAMRAN CT, EDMOND, OK 73013-9040
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/19/2023
Last updated
05/19/2023
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