Provider Demographics
NPI:1902403223
Name:KASHANI, MALLORY ELIZABETH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:ELIZABETH
Last Name:KASHANI
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MALLORY
Other - Middle Name:ELIZABETH
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 20514
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93390-0514
Mailing Address - Country:US
Mailing Address - Phone:607-321-5155
Mailing Address - Fax:
Practice Address - Street 1:212 COFFEE RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-1258
Practice Address - Country:US
Practice Address - Phone:607-321-5155
Practice Address - Fax:661-520-4050
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58653363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant