Healthcare Provider Details

I. General information

NPI: 1699686196
Provider Name (Legal Business Name): TYNIDA GUESS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 S E ST
SAN BERNARDINO CA
92408-2773
US

IV. Provider business mailing address

2080 S E ST
SAN BERNARDINO CA
92408-2773
US

V. Phone/Fax

Practice location:
  • Phone: 909-388-9191
  • Fax:
Mailing address:
  • Phone: 909-388-9191
  • Fax: 909-388-9195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number33219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: