NPIMap

Organization Active NPI

Litos O. Mallare, M.D., Inc.

  • Psychiatry Physician
  • Malibu, CA
National Provider Identifier
1932524485
Registry record updated Jun 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A69317 Issued in CA
Legal business name
LITOS O. MALLARE, M.D., INC.
Practice address
23823 Malibu Rd
Suite 50, #189
Malibu, CA 90265-4628
Phone
(310) 650-8951
Fax
(310) 457-1082
NPI assigned
Feb 20, 2014
Last updated
Jun 15, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
LITOS O. MALLARE, M.D., INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 15, 2015

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

Authorized official

Name
Dr. Litos O. Mallare, M.D.NPI 1457351421
Title
Psychiatrist
Phone
(310) 650-8951

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X A69317 CA Primary

Addresses

Primary practice location

23823 Malibu Rd
Suite 50, #189
Malibu, CA 90265-4628

Mailing address

23823 Malibu Rd
Suite 50, #189
Malibu, CA 90265-4628
Phone (310) 650-8951

Other identifiers 2

IdentifierTypeStateIssuer
00A693172MedicaidCA
ODA693170MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140311001115 CA Part B Supplier - Clinic/Group Practice 2264662311 Receives reassigned benefits from 1 practitioner
Practice locations: Los Angeles, CA

National Provider Directory

National Provider Directory
Part of
Barlow Respiratory Hosptial

Locations

9171 Wilshire Blvd
Ste 310
Beverly Hills, CA 90210
Phone (310) 274-4372

2000 Stadium Way
Los Angeles, CA 90026
Phone (213) 202-6886

23123 Ventura Blvd
Ste 104A
Woodland Hls, CA 91364
Phone (818) 349-6060

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1392854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434326400000",
    "number": "1932524485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23823 MALIBU RD",
            "address_2": "SUITE 50, #189",
            "city": "MALIBU",
            "state": "CA",
            "postal_code": "902654628",
            "telephone_number": "310-650-8951",
            "fax_number": "310-457-1082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23823 MALIBU RD",
            "address_2": "SUITE 50, #189",
            "city": "MALIBU",
            "state": "CA",
            "postal_code": "902654628",
            "telephone_number": "310-650-8951",
            "fax_number": "310-457-1082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LITOS O. MALLARE, M.D., INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LITOS O. MALLARE, M.D., INC.",
        "enumeration_date": "2014-02-20",
        "last_updated": "2015-06-15",
        "status": "A",
        "authorized_official_last_name": "MALLARE",
        "authorized_official_first_name": "LITOS",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "PSYCHIATRIST",
        "authorized_official_telephone_number": "310-650-8951",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A69317",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A693172",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ODA693170",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Malibu, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.