| Litos O. Mallare, M.d., Inc. | |
|
23823 Malibu Rd Suite 50, #189 Malibu CA 90265-4628 | |
| (310) 650-8951 | |
| (310) 457-1082 |
| Full Name | Litos O. Mallare, M.d., Inc. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 23823 Malibu Rd, Malibu, California |
| Authorized Official Name and Position | Litos O. Mallare (PSYCHIATRIST) |
| Authorized Official Contact | 3106508951 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Litos O. Mallare, M.d., Inc. 23823 Malibu Rd Suite 50, #189 Malibu CA 90265-4628 Ph: (310) 650-8951 | Litos O. Mallare, M.d., Inc. 23823 Malibu Rd Suite 50, #189 Malibu CA 90265-4628 Ph: (310) 650-8951 |
| NPI Number | 1932524485 |
|---|---|
| Provider Enumeration Date | 02/20/2014 |
| Last Update Date | 06/15/2015 |
| Medicare PECOS PAC ID | 2264662311 |
|---|---|
| Medicare Enrollment ID | O20140311001115 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932524485 | NPI | - | NPPES |
| 00A693172 | Medicaid | CA | |
| ODA693170 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | A69317 (California) | Primary |
| Provider Name | Litos O Mallare |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457351421 PECOS PAC ID: 0941498240 Enrollment ID: I20110103000100 |
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