Individual
MALICA DEEPTI MANTRALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2601 E ROOSEVELT ST, PHOENIX, AZ 85008-4973
(222) 222-2222
Mailing address
3200 E CAMELBACK RD, STE 250, PHOENIX, AZ 85018-2327
(602) 933-1814
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
59057
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/03/2016
Last updated
02/27/2020
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