Healthcare Provider Details

I. General information

NPI: 1952232209
Provider Name (Legal Business Name): MR. TYLER AUSTIN SMITH I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W LUGONIA AVE
REDLANDS CA
92374-2233
US

IV. Provider business mailing address

37317 WILDWOOD VIEW DR
YUCAIPA CA
92399-9539
US

V. Phone/Fax

Practice location:
  • Phone: 909-307-5300
  • Fax:
Mailing address:
  • Phone: 909-553-3272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: