Dominique Mall,MD,Inc

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

DOMINIQUE MALL,MD,INC

Practice address

13911 Old Harbor LN
#306
Marina del Rey, CA 90292-7395

Phone

(310) 577-9547

Fax

(310) 577-9547

NPI assigned

Jan 23, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Dominique Lucienne Mall, MD

Title

President

Phone

(310) 902-8947

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314144000000",
    "number": "1053465062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13911 OLD HARBOR LN",
            "address_2": "#306",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902927395",
            "telephone_number": "310-577-9547",
            "fax_number": "310-577-9547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13911 OLD HARBOR LN",
            "address_2": "#306",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902927395",
            "telephone_number": "310-577-9547",
            "fax_number": "310-577-9547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOMINIQUE MALL,MD,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2011-08-24",
        "status": "A",
        "authorized_official_last_name": "MALL",
        "authorized_official_first_name": "DOMINIQUE",
        "authorized_official_middle_name": "LUCIENNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-902-8947",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Christelle Joelle Doktor, C.M.T
• Roger Frederic Donenfeld, M.D.
• Douglas J Nishida, OD, a Professional Corporation
• Melissa Dowling, CRNA
• Angelica Duenas, M.D.
• Dura Group

• Nephrology Physician in Marina del Rey, CA
• Providers in Marina del Rey, CA by specialty
• Nephrology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.