Mallam, Mohan

Mallam, Mohan is an sole proprietor health care provider with primary practice located at 303 E Buena Vista St , Barstow CA 92311-2803. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Geriatric Medicine. Allopathic & Osteopathic Physicians / Geriatric Medicine is his primary health care specialty. Mallam, Mohan can be contacted via phone (760) 256-4601.

Contact Information

Primary practice address
303 E Buena Vista St Barstow CA 92311-2803
Phone: (760) 256-4601
Fax: (760) 256-0310
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X A42919 California
Allopathic & Osteopathic Physicians / Geriatric Medicine 207RG0300X A42919 California

Profile Details

NPI number 1538161443
LBN Legal business name Mallam, Mohan
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 10th, 2005
Last updated Mar 11th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1538161443 NPPES
California MEDICAID 00A429190
California MEDICAID LAB73093F

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