Healthcare Provider Details

I. General information

NPI: 1396141008
Provider Name (Legal Business Name): TALINE BEDELIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24318 HEMLOCK AVE
MORENO VALLEY CA
92557-7222
US

IV. Provider business mailing address

24318 HEMLOCK AVE
MORENO VALLEY CA
92557-7222
US

V. Phone/Fax

Practice location:
  • Phone: 951-243-5050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95001638
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: