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General NPI Number Information
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NPI Number | 1528821980
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Entity Type | Individual
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Provider Name | TALIA RENE CLATE FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/30/2024
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 54165 PINE CREST AVE
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City | IDYLLWILD
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State | CA
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Zip | 92549
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Country | US
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Telephone | 951-659-4908
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Fax |
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Provider Business Mailing Address
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Address Line | 28039 SCOTT RD. STE D BOX 255
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City | MURRIETA
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State | CA
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Zip | 92563
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Country | US
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Telephone | 951-265-2340
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 95109090
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95029178
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License Number State | CA
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