MEDICARE: ODOCHI TYLER

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	103TB0200X	Cognitive & Behavioral Psychologist		CA

General Provider Information

NPI Number	:	1891478830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ODOCHI TYLER

Provider Business Mailing Address
First Line	:	2829 N. BELLFLOWER BLVD. #1011
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-1126
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2829 N. BELLFLOWER BLVD. #1011
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-1126
Country	:	US
Telephone Number	:	323-337-2465
Fax Number	:

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

Provider Enumeration Date	:	08/08/2023
Last Update Date	:	08/08/2023

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Directions to “ ODOCHI TYLER ” Practice Location

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