Individual
TYLER DUSTIN DIAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPT
Contact information
Practice address
4441 E KINGS CANYON RD, FRESNO, CA 93702-3604
(550) 600-9180
Mailing address
4441 E KINGS CANYON RD, FRESNO, CA 93702-3604
(559) 600-9180
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
37792
CA
Other
Enumeration date
12/22/2015
Last updated
07/12/2022
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