Healthcare Provider Details

I. General information

NPI: 1154286391
Provider Name (Legal Business Name): ALLISON FANYA GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28245 AVENUE CROCKER STE 220
VALENCIA CA
91355-1201
US

IV. Provider business mailing address

25769 BARNETT LN
STEVENSON RANCH CA
91381-1125
US

V. Phone/Fax

Practice location:
  • Phone: 661-254-7086
  • Fax:
Mailing address:
  • Phone: 661-312-6824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: