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NPI Code Detail

MEDICARE: TYRONZA PRESTON

MEDICARE: TYRONZA PRESTON
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
1103K00000XBehavior Analyst
2253Z00000XIn Home Supportive Care Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508350117
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYRONZA PRESTON
Provider Business Mailing Address
First Line : 2020 PINTO LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-4019
Country : US
Telephone Number : 702-868-2901
Fax Number :
Provider Business Practice Location Address
First Line : 3305 SPRING MOUNTAIN RD STE 107
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-8628
Country : US
Telephone Number : 24-875-4807
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2018
Last Update Date : 10/30/2019

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Directions to “ TYRONZA PRESTON ” Practice Location

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