Provider Demographics
NPI:1215173646
Name:MALLARI, RAY E
Entity type:Individual
Prefix:
First Name:RAY
Middle Name:E
Last Name:MALLARI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8055 TOULON CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-2891
Mailing Address - Country:US
Mailing Address - Phone:904-608-4318
Mailing Address - Fax:
Practice Address - Street 1:1100 CESERY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-5612
Practice Address - Country:US
Practice Address - Phone:904-745-3070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator