Healthcare Provider Details

I. General information

NPI: 1316504988
Provider Name (Legal Business Name): DIANE TYLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1652 SUNNYDALE AVE
SAN FRANCISCO CA
94134-2628
US

IV. Provider business mailing address

1652 SUNNYDALE AVE
SAN FRANCISCO CA
94134-2628
US

V. Phone/Fax

Practice location:
  • Phone: 628-217-5324
  • Fax:
Mailing address:
  • Phone: 628-217-5324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246YR1600X
TaxonomyRegistered Record Administrator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: