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General NPI Number Information
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NPI Number | 1578934642
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Entity Type | Organization
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Legal Business Name | TYLER STREET, MD, PC
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Dates
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Enumeration Date | 10/14/2015
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Last Update Date | 02/23/2016
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Provider Practice Location Address
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Address Line | 1175 TRANCAS ST
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City | NAPA
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State | CA
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Zip | 94558-2907
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Country | US
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Telephone | 707-258-6053
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3269
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City | NAPA
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State | CA
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Zip | 94558-0326
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Country | US
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Telephone | 401-688-0862
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | TYLER C STREET
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Credential | M.D.
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Telephone | 401-688-0862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 138470
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License Number State | CA
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