Healthcare Provider Details

I. General information

NPI: 1104762947
Provider Name (Legal Business Name): DEISMEN TYRELL ARMSTRONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14949 RIO GRANDE DR
MORENO VALLEY CA
92553-5058
US

IV. Provider business mailing address

14949 RIO GRANDE DR
MORENO VALLEY CA
92553-5058
US

V. Phone/Fax

Practice location:
  • Phone: 351-867-6543
  • Fax:
Mailing address:
  • Phone: 351-867-6543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: