Individual
TYLER BRADSHAW THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
34, FARENHOLT AVE, SAN DIEGO, CA 92134-0001
(619) 532-7962
Mailing address
10061 RIO SAN DIEGO DR APT 302, SAN DIEGO, CA 92108-5659
(740) 424-5556
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
59672019
MILITARY
—
Enumeration date
06/24/2019
Last updated
06/24/2019
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