Provider Demographics
NPI:1306198429
Name:MALLARI, RANDY V (PMHNP-BC, FNP-BC)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:V
Last Name:MALLARI
Suffix:
Gender:M
Credentials:PMHNP-BC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10250 N 124TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-5201
Mailing Address - Country:US
Mailing Address - Phone:602-908-8580
Mailing Address - Fax:480-590-6113
Practice Address - Street 1:10250 N 124TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-5201
Practice Address - Country:US
Practice Address - Phone:480-400-0850
Practice Address - Fax:602-860-6050
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95034292363LF0000X
HIAPRN-5050363LF0000X
NM83016363LP0808X
NV873430363LP0808X
OR10041249363LP0808X
AZ321587363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ096781Medicaid
AZRN207973OtherARIZONA STATE BOARD OF NURSING
HIAPRN-5050OtherHAWAII BOARD OF NURSING
HIRN123612OtherHAWAII BOARD OF NURSING
AZRN207973OtherARIZONA STATE BOARD OF NURSING
AZBH6716OtherARIZONA DEPARTMENT OF HEALTH SERVICES