Healthcare Provider Details

I. General information

NPI: 1639945686
Provider Name (Legal Business Name): TYLER CZAK ASW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9265 SKY PARK CT STE 100
SAN DIEGO CA
92123-4375
US

IV. Provider business mailing address

4021 8TH AVE APT 208
SAN DIEGO CA
92103-2225
US

V. Phone/Fax

Practice location:
  • Phone: 702-539-7001
  • Fax:
Mailing address:
  • Phone: 702-539-7001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number123514
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number139458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: