Healthcare Provider Details

I. General information

NPI: 1558608778
Provider Name (Legal Business Name): MALLORY ANNE MATHIAS B.C.B.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2013
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 MARKET ST
VENTURA CA
93003-7783
US

IV. Provider business mailing address

4880 MARKET ST
VENTURA CA
93003-7783
US

V. Phone/Fax

Practice location:
  • Phone: 818-605-7451
  • Fax:
Mailing address:
  • Phone: 805-650-7827
  • Fax: 805-650-1385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: