MEDICARE: MARIO MCFALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1912842378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIO MCFALL

Provider Business Mailing Address
First Line	:	5225 CANYON CREST DR STE 71-413
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-6301
Country	:	US
Telephone Number	:	951-682-0088
Fax Number	:	888-909-4209

Provider Business Practice Location Address
First Line	:	5800 S EASTERN AVE STE 518
Second Line	:
City	:	COMMERCE
State	:	CA
Zip	:	90040-4016
Country	:	US
Telephone Number	:	323-345-4322
Fax Number	:	888-909-4209

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2026
Last Update Date	:	04/22/2026

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Directions to “ MARIO MCFALL ” Practice Location

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