Healthcare Provider Details

I. General information

NPI: 1275464190
Provider Name (Legal Business Name): TYLER BARILLA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 PEDLEY RD
JURUPA VALLEY CA
92509-3966
US

IV. Provider business mailing address

9350 THE RESORT PKWY UNIT 2633
RANCHO CUCAMONGA CA
91730-9228
US

V. Phone/Fax

Practice location:
  • Phone: 951-360-4100
  • Fax:
Mailing address:
  • Phone: 909-635-9046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP38315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: