Healthcare Provider Details

I. General information

NPI: 1811809577
Provider Name (Legal Business Name): TYLER ROGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7233 E BASELINE RD STE 106
MESA AZ
85209-5007
US

IV. Provider business mailing address

3310 S COLT DR
GILBERT AZ
85297-7770
US

V. Phone/Fax

Practice location:
  • Phone: 480-477-3203
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number22112
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: