Individual
MALLORY FOSSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PNP-PC
Contact information
Practice address
282 WASHINGTON ST, HARTFORD, CT 06106-3322
(860) 837-5207
Mailing address
3701 WILSHIRE BLVD, SUITE 600, LOS ANGELES, CA 90010-2814
(323) 361-3550
(323) 361-8502
Taxonomy
Speciality
Code
Description
License number
State
207LP3000X
Pediatric Anesthesiology Physician
Primary
95003548
CA
363LP0200X
Pediatric Nurse Practitioner
12.008276
CT
363LP0200X
Pediatric Nurse Practitioner
95003548
CA
Other
Enumeration date
12/10/2015
Last updated
09/12/2022
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