Healthcare Provider Details

I. General information

NPI: 1235042060
Provider Name (Legal Business Name): NEVAEH SKY WIRTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 UNIVERSITY PKWY
SAN BERNARDINO CA
92407-2318
US

IV. Provider business mailing address

5500 UNIVERSITY PARKWAY, SAN BERNARDINO
SAN BERNARDINO CA
92374-2318
US

V. Phone/Fax

Practice location:
  • Phone: 909-537-5495
  • Fax: 909-537-5495
Mailing address:
  • Phone: 909-537-5495
  • Fax: 909-537-5495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: