Healthcare Provider Details

I. General information

NPI: 1912842378
Provider Name (Legal Business Name): MARIO MCFALL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 S EASTERN AVE STE 518
COMMERCE CA
90040-4016
US

IV. Provider business mailing address

5225 CANYON CREST DR STE 71-413
RIVERSIDE CA
92507-6301
US

V. Phone/Fax

Practice location:
  • Phone: 323-345-4322
  • Fax: 888-909-4209
Mailing address:
  • Phone: 951-682-0088
  • Fax: 888-909-4209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: