Individual
DR. MOHAN MALLAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
303 E BUENA VISTA ST, BARSTOW, CA 92311-2803
(760) 256-4601
(760) 256-0310
Mailing address
303 E BUENA VISTA ST, BARSTOW, CA 92311-2803
(760) 256-4601
(760) 256-0310
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A42919
CA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
A42919
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A429190
—
CA
05
—
LAB73093F
—
CA
Enumeration date
08/10/2005
Last updated
03/11/2008
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