Healthcare Provider Details

I. General information

NPI: 1730159716
Provider Name (Legal Business Name): SHERRI R TYSCH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 LA VENTA DR STE 103
WESTLAKE VILLAGE CA
91361-3757
US

IV. Provider business mailing address

1250 LA VENTA DR STE 103
WESTLAKE VILLAGE CA
91361-3757
US

V. Phone/Fax

Practice location:
  • Phone: 805-495-0841
  • Fax: 805-446-4891
Mailing address:
  • Phone: 805-495-0841
  • Fax: 805-446-4891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A5794
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: