| Organization Name: | DOMINIQUE MALL,MD,INC |
| NPI Number: | 1053465062 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DOMINIQUE LUCIENNE MALL (PRESIDENT) |
| Mailing Address: | 13911 Old Harbor Ln #306 Marina Del Rey |
| State: | CA US |
| Postal Code: | 902927395 |
| Phone Number: | 3105779547 |
| Fax Number: | 3105779547 |
| NPI Enumeration Date: | 01/23/2007 |
| NPI Last Update Date: | 08/24/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RN0300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Nephrology |
| Taxonomy Definition: | An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |