Individual
EMILY MALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3760 CONVOY ST, SUITE 204, SAN DIEGO, CA 92111-3742
(858) 514-0375
Mailing address
1505 MISSOURI ST, SAN DIEGO, CA 92109-3039
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
14562
CA
Other
Enumeration date
06/12/2012
Last updated
10/01/2014
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