Healthcare Provider Details

I. General information

NPI: 1427635374
Provider Name (Legal Business Name): TYLER JOSEPH HOHNHOLT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR
SAN DIEGO CA
92103-9000
US

IV. Provider business mailing address

200 W ARBOR DR
SAN DIEGO CA
92103-9000
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-6268
  • Fax:
Mailing address:
  • Phone: 619-543-6268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number13798491-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: