Healthcare Provider Details

I. General information

NPI: 1093529893
Provider Name (Legal Business Name): MICAELA FIEDLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 E RINCON ST STE 219
CORONA CA
92879-1387
US

IV. Provider business mailing address

3282 MALIBU CRK
JURUPA VALLEY CA
92509-0861
US

V. Phone/Fax

Practice location:
  • Phone: 951-817-5328
  • Fax:
Mailing address:
  • Phone: 909-684-3353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: