Healthcare Provider Details

I. General information

NPI: 1881029213
Provider Name (Legal Business Name): ASHLEY ELIZABETH TYRREL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ALHAMBRA AVE
MARTINEZ CA
94553-3156
US

IV. Provider business mailing address

1547 PALOS VERDES MALL STE 232
WALNUT CREEK CA
94597-2228
US

V. Phone/Fax

Practice location:
  • Phone: 925-263-6556
  • Fax:
Mailing address:
  • Phone: 925-263-6556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA 127248
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA127248
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: