Healthcare Provider Details

I. General information

NPI: 1013480649
Provider Name (Legal Business Name): TYLER J PRICE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BOX 555657 1ST MEDICAL BATTALION 1ST MARINE LOGISTICS GROUP
CAMP PENDLETON CA
92055-5657
US

IV. Provider business mailing address

4666 UTAH ST UNIT 3
SAN DIEGO CA
92116-3193
US

V. Phone/Fax

Practice location:
  • Phone: 619-752-0215
  • Fax: 510-721-0968
Mailing address:
  • Phone: 858-449-2735
  • Fax: 619-532-6003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01084739A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number01084739A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA200779
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: