Active NPI
Emily Mallard
- Pediatric Occupational Therapist
- San Diego, CA
National Provider Identifier
1598027997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 14562
- Practice address
- 3760 Convoy St
Suite 204
San Diego, CA 92111-3742 - Phone
- (858) 514-0375
- NPI assigned
- Jun 12, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 14562 | CA | Primary |
Addresses
Primary practice location
3760 Convoy St
Suite 204
San Diego, CA 92111-3742
Mailing address
1505 Missouri St
San Diego, CA 92109-3039
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14562 | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339459200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412121600000",
"number": "1598027997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1505 MISSOURI ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921093039"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3760 CONVOY ST",
"address_2": "SUITE 204",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921113742",
"telephone_number": "858-514-0375"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLARD",
"first_name": "EMILY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-12",
"last_updated": "2014-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "CA",
"license": "14562",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.