Varun Mallela

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

65066 Issued in CA

Practice address

5690 N Fresno St Ste 101
Fresno, CA 93710-8332

Phone

(559) 436-3470

NPI assigned

Oct 30, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1446163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446163200000",
    "number": "1134592066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5690 N FRESNO ST STE 101",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937108332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5690 N FRESNO ST STE 101",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937108332",
            "telephone_number": "559-436-3470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLELA",
        "first_name": "VARUN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-10-30",
        "last_updated": "2015-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "65066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shazia Tabasum Malik, NURSE PRACTITIONER
• Malintze Gutierrez, D.O., Inc.
• Malintze Gutierrez, Inc.
• Gail Maureen Mallard-Warren, MD
• Myla Mallari
• Konstantin Roman Malley
• Natalya G Malley, MD
• Roman B Malley, MD
• Sheila Orallo Mallory, N. P.
• Malo Sports Rehabilitation and Physical Therapy Inc.

• General Practice Dentistry in Fresno, CA
• Providers in Fresno, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.