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General NPI Number Information
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NPI Number | 1013554492
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Entity Type | Individual
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Provider Name | JEREMIAH TYLER WYLIE
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Gender | Male
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Dates
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Enumeration Date | 12/04/2019
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 2141 PALOMAR AIRPORT RD STE 350
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City | CARLSBAD
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State | CA
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Zip | 92011-1451
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Country | US
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Telephone | 760-710-2460
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Fax |
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Provider Business Mailing Address
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Address Line | 9406 PENNYWOOD RD
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City | SANTEE
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State | CA
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Zip | 92071-1312
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Country | US
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Telephone | 619-701-1610
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Fax |
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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 | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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