Healthcare Provider Details

I. General information

NPI: 1972441814
Provider Name (Legal Business Name): TEYONKA PHILLIPS LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TEYONKA BENNETT

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 N GAREY AVE
POMONA CA
91767-2722
US

IV. Provider business mailing address

16225 ARROW BLVD APT K153
FONTANA CA
92335-8826
US

V. Phone/Fax

Practice location:
  • Phone: 909-623-6131
  • Fax: 909-865-9281
Mailing address:
  • Phone: 909-809-8951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number35129
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: