Provider Demographics
NPI:1184331688
Name:MALI, SHAULVI SAMIR
Entity type:Individual
Prefix:
First Name:SHAULVI
Middle Name:SAMIR
Last Name:MALI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WATERBURY LN
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-8237
Mailing Address - Country:US
Mailing Address - Phone:617-775-6922
Mailing Address - Fax:
Practice Address - Street 1:774 S PLACENTIA AVE STE 200
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6838
Practice Address - Country:US
Practice Address - Phone:415-812-9295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA423322251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty