Healthcare Provider Details

I. General information

NPI: 1972441814
Provider Name (Legal Business Name): TEYONKA PHILLIPS
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: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 RANDY ST APT D
UPLAND CA
91786-5131
US

IV. Provider business mailing address

1364 RANDY ST APT D
UPLAND CA
91786-5131
US

V. Phone/Fax

Practice location:
  • Phone: 909-809-8951
  • Fax:
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: