Basic Information
| Provider Information | |||||||||
| NPI: | 1982090841 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AVILES | ||||||||
| FirstName: | TANYA | ||||||||
| MiddleName: | DENISE | ||||||||
| NamePrefix: | MISS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 975 | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925020975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513604175 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3924 RIVERVIEW DR | ||||||||
| Address2: | |||||||||
| City: | JURUPA VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925096611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513604175 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2015 | ||||||||
| LastUpdateDate: | 11/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 130617 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.