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General NPI Number Information
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NPI Number | 1013480649
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Entity Type | Individual
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Provider Name | TYLER J PRICE MD
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Gender | Male
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Dates
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Enumeration Date | 01/07/2019
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | BOX 555657 1ST MEDICAL BATTALION 1ST MARINE LOGISTICS GROUP
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City | CAMP PENDLETON
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State | CA
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Zip | 92055-5657
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Country | US
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Telephone | 619-752-0215
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Fax | 510-721-0968
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Provider Business Mailing Address
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Address Line | 4666 UTAH ST UNIT 3
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City | SAN DIEGO
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State | CA
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Zip | 92116-3193
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Country | US
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Telephone | 858-449-2735
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Fax | 619-532-6003
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 01084739A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 01084739A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A200779
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License Number State | CA
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