Healthcare Provider Details

I. General information

NPI: 1336734698
Provider Name (Legal Business Name): TYLER C JENKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 S MAYFLOWER AVE STE 220
MONROVIA CA
91016-5239
US

IV. Provider business mailing address

1333 S MAYFLOWER AVE STE 22
MONROVIA CA
91016-4066
US

V. Phone/Fax

Practice location:
  • Phone: 818-241-6780
  • Fax:
Mailing address:
  • Phone: 818-241-6780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-86564
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: