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NPI Code Detail

MEDICARE: ALYSIANA ELIZALDE TAHA

MEDICARE: ALYSIANA ELIZALDE TAHA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker118714CA

General Provider Information

NPI Number : 1457289662
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALYSIANA ELIZALDE TAHA
Provider Business Mailing Address
First Line : PO BOX 2384
Second Line :
City : CORONA
State : CA
Zip : 92878-2384
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 15217 SAN BERNARDINO AVE
Second Line :
City : FONTANA
State : CA
Zip : 92335-5327
Country : US
Telephone Number : 951-643-2150
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2026
Last Update Date : 05/11/2026

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Directions to “ ALYSIANA ELIZALDE TAHA ” Practice Location

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