Healthcare Provider Details

I. General information

NPI: 1295440873
Provider Name (Legal Business Name): ALEXIS CHARLOTTE TYLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date: 09/04/2025
Reactivation Date: 09/25/2025

III. Provider practice location address

734 10TH AVE
SAN DIEGO CA
92101-6502
US

IV. Provider business mailing address

734 10TH AVE
SAN DIEGO CA
92101-6502
US

V. Phone/Fax

Practice location:
  • Phone: 619-239-4663
  • Fax:
Mailing address:
  • Phone: 619-239-4663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: