DR. PRAVEENA GOPINATHA MALLYA (NPI# 1922020635) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922020635 |
| Entity Type | Individual |
| Full Name | DR. PRAVEENA GOPINATHA MALLYA |
| Credential | DO |
| Practice Address |
795 El Camino Real Palo Alto CA 94302-2302 |
| Mailing Address |
2350 W. El Camino Real 2nd Floor Mountain View CA 94040-6203 |
| Practice Telephone | 6508536558 |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2016-09-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 2OA12814 | CA | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | OS013741 | PA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NJ | 0219525 | 05 |
| Street Address |
795 EL CAMINO REAL |
| City | PALO ALTO |
| State | CA |
| Zip Code | 94302-2302 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346248085 | Wendy Levine | Occupational Therapist | 795 El Camino Real, Palo Alto, CA 94301-2302 | 2005-07-07 |
| 1932706637 | Ashley Powell | Occupational Therapist | 795 El Camino Real, Palo Alto, CA 94301-2302 | 2020-10-06 |
| 1568069268 | Madeline Manion | Physical Therapist | 795 El Camino Real, Palo Alto, CA 94301-2302 | 2020-10-06 |
| 1245847565 | Sandrine Nicolet | Physical Therapist | 795 El Camino Real, Palo Alto, CA 94301-2302 | 2020-09-30 |
| 1164058731 | Shannon Tram Anh Trinh | Pharmacist | 795 El Camino Real, Palo Alto, CA 94301-2302 | 2020-03-16 |
| 1205460243 | Caitlin Schubmehl | Nurse Practitioner | 795 El Camino Real, Palo Alto, CA 94301-2302 | 2020-02-28 |
| 1518502350 | Odiri Maku | Nurse Practitioner | 795 El Camino Real, Palo Alto, CA 94301-2302 | 2019-11-15 |
| 1841847167 | Rachel Zatkin Kizuka | Registered Nurse | 795 El Camino Real, Palo Alto, CA 94301-2302 | 2019-08-21 |
| 1497300974 | Christopher Duane Asplund | Physical Therapist | 795 El Camino Real, Palo Alto, CA 94301-2302 | 2019-08-02 |
| 1033673991 | Jingyun Yao | Speech-Language Pathologist | 795 El Camino Real, Palo Alto, CA 94301 | 2019-01-24 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306865241 | Joseph Liao | Urology | 3801 Miranda Ave. (112), Palo Alto, CA 94302 | 2006-07-19 |
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386136257 | Alice Bertaina Bertaina | Pediatrics | 1000 Welch Rd Ste 301, Palo Alto, CA 94304-1811 | 2018-06-05 |
| 1881049914 | Gary Sharron | Pediatrics | 2015 Byron St., Palo Alto, CA 94301-4004 | 2016-04-26 |
| 1265792295 | Neela Lakshmi Penumarthy | Pediatrics | 880 Aspen Way, Palo Alto, CA 94303-4421 | 2012-05-23 |
| 1932475035 | Geri Ottaviano Landman | Pediatrics | 723 Welch Rd, Palo Alto, CA 94304-1601 | 2012-03-23 |
| 1225309859 | Lynne Frances Bernatowicz | Pediatrics | 4015 Arbol Dr, Palo Alto, CA 94306-3170 | 2012-01-12 |
| 1114202694 | Edward L Schor | Pediatrics | 400 Hamilton Ave, Suite 340, Palo Alto, CA 94301-1833 | 2011-10-17 |
| 1770803538 | Lynne Coe Huffman | Pediatrics | 750 Welch Road, #212, Palo Alto, CA 94304 | 2010-06-03 |
| 1285862771 | Judith Joan Palmer | Pediatrics | 441 Carolina Ln, Palo Alto, CA 94306-4124 | 2009-06-23 |
| 1043423965 | Mehran Mosley | Pediatrics | 770 Welch Rd Ste 100, Palo Alto, CA 94304-1505 | 2007-05-07 |
| 1861615965 | Stefanie M Wauk | Pediatrics | 555 Bryant St # 177, Palo Alto, CA 94301-1704 | 2007-04-10 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.