Healthcare Provider Details

I. General information

NPI: 1902700537
Provider Name (Legal Business Name): MALLORY FENCIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24355 LYONS AVE
SANTA CLARITA CA
91321-2300
US

IV. Provider business mailing address

24224 DALGO DR
SANTA CLARITA CA
91355-1915
US

V. Phone/Fax

Practice location:
  • Phone: 661-644-9673
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: