Healthcare Provider Details

I. General information

NPI: 1992461214
Provider Name (Legal Business Name): TYLER FLYNN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4470 W SUNSET BLVD STE
LOS ANGELES CA
90027-6309
US

IV. Provider business mailing address

PO BOX 9187
GLENDALE CA
91226-0187
US

V. Phone/Fax

Practice location:
  • Phone: 213-282-4035
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105676
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: