Basic Information
| Provider Information | |||||||||
| NPI: | 1477844793 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALHOTRA | ||||||||
| FirstName: | LAVINA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 LA CASA VIA | ||||||||
| Address2: | STE 211 | ||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945983046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142938704 | ||||||||
| FaxNumber: | 6142934063 | ||||||||
| Practice Location | |||||||||
| Address1: | 395 W 12TH AVE RM 654 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432101267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142938704 | ||||||||
| FaxNumber: | 6142934063 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2011 | ||||||||
| LastUpdateDate: | 09/16/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 09/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 193400000X | A138713 | CA | Y | Group | Single Specialty |
No ID Information.