Individual
MR. JOHN A MALLERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
150 CATHERINE LANE, #D, GRASS VALLEY, CA 95945
(530) 477-8358
(530) 477-2015
Mailing address
150 CATHERINE LANE, #D, GRASS VALLEY, CA 95945
(530) 477-8358
(530) 477-2015
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
00G51106
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G511061
MEDICARE PTAN
CA
05
—
GR0045980
—
CA
Enumeration date
01/19/2006
Last updated
04/22/2010
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