Individual
DOMINIQUE LUCIENNE MALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD.
Contact information
Practice address
11211 SEPULVEDA BLVD, MISSION HILLS, CA 91345-1115
(818) 365-9531
Mailing address
PO BOX 9602, MISSION HILLS, CA 91346-9602
(818) 837-5637
(818) 837-5589
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
A86680
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0A8668000
—
CA
Enumeration date
05/23/2006
Last updated
07/17/2012
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