Provider Demographics
NPI:1962571216
Name:MALLA, SABITA (MD)
Entity type:Individual
Prefix:
First Name:SABITA
Middle Name:
Last Name:MALLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23928 LYONS AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2454
Mailing Address - Country:US
Mailing Address - Phone:661-799-7007
Mailing Address - Fax:661-799-7215
Practice Address - Street 1:23928 LYONS AVE STE 202
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-2454
Practice Address - Country:US
Practice Address - Phone:661-799-7007
Practice Address - Fax:661-799-7215
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90206207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAN/AMedicare UPIN