MEDICARE: TAYLOR TYCE-GREEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1518895622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR TYCE-GREEN

Provider Business Mailing Address
First Line	:	1720 N FULLER AVE APT 547
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-3078
Country	:	US
Telephone Number	:	240-481-7955
Fax Number	:

Provider Business Practice Location Address
First Line	:	12925 YUKON AVE
Second Line	:
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-5421
Country	:	US
Telephone Number	:	310-644-9216
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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Directions to “ TAYLOR TYCE-GREEN ” Practice Location

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