Healthcare Provider Details

I. General information

NPI: 1811889454
Provider Name (Legal Business Name): TYLER R PILCHER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N AURORA ST STE 6
STOCKTON CA
95202-2276
US

IV. Provider business mailing address

PO BOX 798
LOCKEFORD CA
95237-0798
US

V. Phone/Fax

Practice location:
  • Phone: 209-327-7241
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-MYVXTO
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: