Provider Demographics
NPI:1154396661
Name:MALLARI, CHRISTOPHER ALFONSO (PA-C)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:ALFONSO
Last Name:MALLARI
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:8791 CONFERENCE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-5822
Mailing Address - Country:US
Mailing Address - Phone:239-344-9327
Mailing Address - Fax:239-247-9327
Practice Address - Street 1:13782 PLANTATION RD
Practice Address - Street 2:BUILDING 4, SUITE 201
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4462
Practice Address - Country:US
Practice Address - Phone:239-343-1105
Practice Address - Fax:239-343-1106
Is Sole Proprietor?:No
Enumeration Date:2006-02-19
Last Update Date:2024-06-20
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Provider Licenses
StateLicense IDTaxonomies
FLPA9103134363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP85375Medicare UPIN