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General NPI Number Information
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NPI Number | 1023996097
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Entity Type | Individual
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Provider Name | TINA LATRICE CONLEY MS
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Gender | Female
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Dates
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Enumeration Date | 08/26/2025
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 4300 LATHAM ST STE 200
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City | RIVERSIDE
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State | CA
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Zip | 92501-4334
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Country | US
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Telephone | 951-922-5792
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Fax |
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Provider Business Mailing Address
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Address Line | 4112 MELROSE ST APT 19
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City | RIVERSIDE
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State | CA
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Zip | 92504-2533
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Country | US
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Telephone | 951-756-2307
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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