Healthcare Provider Details

I. General information

NPI: 1144482621
Provider Name (Legal Business Name): TYLER C STREET MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 VILLA LN STE 280
NAPA CA
94558-6415
US

IV. Provider business mailing address

3434 VILLA LN STE 280
NAPA CA
94558-6415
US

V. Phone/Fax

Practice location:
  • Phone: 707-927-3508
  • Fax: 707-266-1627
Mailing address:
  • Phone: 707-927-3508
  • Fax: 707-266-1627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number138470
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: