Healthcare Provider Details

I. General information

NPI: 1033097324
Provider Name (Legal Business Name): TYLER ANGLIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 S N ST
LOMPOC CA
93436-6606
US

IV. Provider business mailing address

1301 N A ST
LOMPOC CA
93436-3516
US

V. Phone/Fax

Practice location:
  • Phone: 805-742-2600
  • Fax:
Mailing address:
  • Phone: 805-742-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: