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Dionetta Mallory
NPI 1053965202 · on the registry since 2019 · sole proprietor
Practice
- Address
- 2510 N California St
Stockton, CA 95204 - Organisation at this address
- Port City Operating Company, Llc
Inferred from a shared address, not stated in the registry.
- Clinicians at this address
- 5
Additional practice sites
- 2510 N California St, Stockton, CA
Registry record
- Primary taxonomy
- 1041C0700X
1041C0700X
- Licence states on file
- CA
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2019-07-26
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in California