Healthcare Provider Details

I. General information

NPI: 1780871574
Provider Name (Legal Business Name): TANIKA GAYLE PSY. D., MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 10/17/2020
Certification Date: 10/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5051 CANYON CREST DR SUITE 204
RIVERSIDE CA
92507-6099
US

IV. Provider business mailing address

5051 CANYON CREST DR SUITE 204
RIVERSIDE CA
92507-6099
US

V. Phone/Fax

Practice location:
  • Phone: 951-682-1488
  • Fax:
Mailing address:
  • Phone: 951-682-1488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY23903
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: