Healthcare Provider Details

I. General information

NPI: 1215631601
Provider Name (Legal Business Name): TYSON SCOTT RICE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 W 3RD ST STE 113E
LOS ANGELES CA
90048-5901
US

IV. Provider business mailing address

4140 W 190TH ST FL 2
TORRANCE CA
90504-5513
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-9454
  • Fax:
Mailing address:
  • Phone: 310-423-9454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A25344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: