Healthcare Provider Details

I. General information

NPI: 1477415602
Provider Name (Legal Business Name): WELLNESS EQUITY ALLIANCE CA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47915 OASIS ST
INDIO CA
92201-6950
US

IV. Provider business mailing address

47-915 OASIS STREET
IN CA
92201
US

V. Phone/Fax

Practice location:
  • Phone: 818-298-9444
  • Fax: 3
Mailing address:
  • Phone: 818-298-9444
  • Fax: 3

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: TYLER EVANS
Title or Position: CEO
Credential: MD
Phone: 818-298-9444