Healthcare Provider Details

I. General information

NPI: 1609654755
Provider Name (Legal Business Name): TYLER BURNS PA-C, CAQ-PSYCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 AIRWAY AVE STE G1
COSTA MESA CA
92626-4624
US

IV. Provider business mailing address

1310 W STEWART DR STE 306
ORANGE CA
92868-3838
US

V. Phone/Fax

Practice location:
  • Phone: 714-545-5550
  • Fax:
Mailing address:
  • Phone: 714-545-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA63360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: