Active NPI
Mallory Beth Fehrensen
- Behavior Technician
- Temecula, CA
National Provider Identifier
1417455270
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 28991 Old Town Front St Ste 208
Temecula, CA 92590-5804 - Phone
- (858) 444-8823
- NPI assigned
- Jan 26, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | CA | Primary |
Addresses
Primary practice location
28991 Old Town Front St Ste 208
Temecula, CA 92590-5804
Mailing address
28991 Old Town Front St Ste 208
Temecula, CA 92590-5804
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1516924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1516924800000",
"number": "1417455270",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28991 OLD TOWN FRONT ST STE 208",
"city": "TEMECULA",
"state": "CA",
"postal_code": "925905804"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28991 OLD TOWN FRONT ST STE 208",
"city": "TEMECULA",
"state": "CA",
"postal_code": "925905804",
"telephone_number": "858-444-8823"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FEHRENSEN",
"first_name": "MALLORY",
"middle_name": "BETH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-01-26",
"last_updated": "2018-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Temecula, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.