MEDICARE: TYLER JAMES REYNOLDS IDHS

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	1710I1003X	Independent Duty Medical Technicians		CA

General Provider Information

NPI Number	:	1972467223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER JAMES REYNOLDS IDHS

Provider Business Mailing Address
First Line	:	599 TOMALES RD
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-5002
Country	:	US
Telephone Number	:	707-765-7200
Fax Number	:

Provider Business Practice Location Address
First Line	:	599 TOMALES RD
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-5002
Country	:	US
Telephone Number	:	707-765-7200
Fax Number	:

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

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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