Healthcare Provider Details

I. General information

NPI: 1609537745
Provider Name (Legal Business Name): MICHELLE VALERIO TANALEON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2021
Last Update Date: 04/18/2023
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8112 MILLIKEN AVE STE 201
RANCHO CUCAMONGA CA
91730-7473
US

IV. Provider business mailing address

8112 MILLIKEN AVE STE 201
RANCHO CUCAMONGA CA
91730-7473
US

V. Phone/Fax

Practice location:
  • Phone: 909-466-7337
  • Fax:
Mailing address:
  • Phone: 909-466-7337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95019537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: