Organization
MALLAVIA OD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID F MALLAVIA OD (PRESIDENT)
(928) 645-2772
Entity
Organization
Contact information
Practice address
124 SIXTH AVE, BOX 1806, PAGE, AZ 86040-1806
(928) 645-2772
(928) 645-9508
Mailing address
PO BOX 1806, 124 6 AVE, PAGE, AZ 86040-1806
(928) 645-2772
(928) 645-9508
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1379
AZ
Other
Enumeration date
05/04/2007
Last updated
12/31/2007
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