Healthcare Provider Details

I. General information

NPI: 1720437726
Provider Name (Legal Business Name): TYLER HILL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 06/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 W 162ND ST
GARDENA CA
90247-3734
US

IV. Provider business mailing address

14708 HALLDALE AVE
GARDENA CA
90247-2885
US

V. Phone/Fax

Practice location:
  • Phone: 310-217-9537
  • Fax:
Mailing address:
  • Phone: 310-217-9537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: