Facts
- Status
- A
- Type
- Organization
- Enumeration date
- 2013-06-03
- Last updated
- 2026-01-02
Licenses
The registry row did not include a license.
Location
- Practice location
- 4168 COUNTY ROAD 444
- City
- WAELDER TX
- Postal code
- 789595328
- Phone
- 888-852-6672
Organization contact
- Name
- NORALYS MALLO
- Title
- Authorized Official
- Phone
- 7862210940
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.