Healthcare Provider Details

I. General information

NPI: 1194619031
Provider Name (Legal Business Name): TALIA WYLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 GREEN RIVER RD STE 313
CORONA CA
92878-9437
US

IV. Provider business mailing address

10300 ARROW RTE
RANCHO CUCAMONGA CA
91730-4794
US

V. Phone/Fax

Practice location:
  • Phone: 502-297-0133
  • Fax:
Mailing address:
  • Phone:
  • 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: