Healthcare Provider Details

I. General information

NPI: 1568881613
Provider Name (Legal Business Name): TYLER FREW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 W ARROW RTE STE 5C
UPLAND CA
91786-9450
US

IV. Provider business mailing address

2440 W ARROW RTE STE 5C
UPLAND CA
91786-9450
US

V. Phone/Fax

Practice location:
  • Phone: 909-768-8885
  • Fax:
Mailing address:
  • Phone: 909-768-8885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA140835
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: