Healthcare Provider Details

I. General information

NPI: 1528821980
Provider Name (Legal Business Name): TALIA RENE CLATE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 02/25/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54165 PINE CREST AVE
IDYLLWILD CA
92549
US

IV. Provider business mailing address

28039 SCOTT RD. STE D BOX 255
MURRIETA CA
92563
US

V. Phone/Fax

Practice location:
  • Phone: 951-659-4908
  • Fax:
Mailing address:
  • Phone: 951-265-2340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95029178
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95109090
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: