Healthcare Provider Details

I. General information

NPI: 1952910697
Provider Name (Legal Business Name): DAYLISI TALAVERA-HERNANDEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAYLISI TALAVERA

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34324 YUCAIPA BLVD
YUCAIPA CA
92399-2496
US

IV. Provider business mailing address

25910 ACERO STE 160
MISSION VIEJO CA
92691-2777
US

V. Phone/Fax

Practice location:
  • Phone: 909-790-1300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number137827
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: