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General NPI Number Information
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NPI Number | 1215729868
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Entity Type | Organization
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Legal Business Name | TYD PROVIDER SERVICES
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Dates
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Enumeration Date | 05/20/2025
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 355 S GRAND STE 2450
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City | LOS ANGELES
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State | CA
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Zip | 90071-1560
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Country | US
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Telephone | 657-200-9124
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Fax |
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Provider Business Mailing Address
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Address Line | 355 S GRAND AVE STE 2450
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City | LOS ANGELES
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State | CA
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Zip | 90071-9500
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Country | US
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Telephone | 657-200-9124
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DOMINIQUE DUNN
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Credential |
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Telephone | 614-648-4680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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