Provider Demographics
NPI:1720885320
Name:LALL, PALLAVI MANGAL (NP)
Entity type:Individual
Prefix:MRS
First Name:PALLAVI
Middle Name:MANGAL
Last Name:LALL
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 SHOEMAKER DR
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-6900
Mailing Address - Country:US
Mailing Address - Phone:347-893-8857
Mailing Address - Fax:
Practice Address - Street 1:714 SHOEMAKER DR
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-6900
Practice Address - Country:US
Practice Address - Phone:347-893-8857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031917363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily