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NPI Code Detail

MEDICARE: TYLER SAKRAIDA

MEDICARE: TYLER SAKRAIDA
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
1101Y00000XCounselorCG60488055WA
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1982013405
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYLER SAKRAIDA
Provider Business Mailing Address
First Line : 1025 ATLANTIC AVE STE 101
Second Line :
City : ALAMEDA
State : CA
Zip : 94501-1188
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1025 ATLANTIC AVE STE 101
Second Line :
City : ALAMEDA
State : CA
Zip : 94501-1188
Country : US
Telephone Number : 510-268-8120
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2014
Last Update Date : 12/08/2021

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Directions to “ TYLER SAKRAIDA ” Practice Location

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