Provider Demographics
NPI:1982402954
Name:MALLARI, BERNADETH TAN
Entity type:Individual
Prefix:MISS
First Name:BERNADETH
Middle Name:TAN
Last Name:MALLARI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 CIVIC DR STE E
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-1949
Mailing Address - Country:US
Mailing Address - Phone:925-914-9361
Mailing Address - Fax:855-772-6228
Practice Address - Street 1:395 CIVIC DR STE E
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-1949
Practice Address - Country:US
Practice Address - Phone:925-914-9361
Practice Address - Fax:855-772-6228
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA02325571246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy