Individual
TYRONE LESLIE HARDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5565 GROSSMONT CENTER DR, BLDG. 1, SUITE 119, LA MESA, CA 91942-3020
(619) 464-3153
(619) 464-3429
Mailing address
5565 GROSSMONT CENTER DR, BLDG. 1, SUITE 119, LA MESA, CA 91942-3020
(619) 464-3153
(619) 464-3429
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
G57014
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G570140
—
CA
01
—
1962574715
NPI CORPORATE NUMBER
CA
01
—
ZZZ56955Z
BLUE SHIELD
CA
Enumeration date
05/15/2007
Last updated
07/08/2007
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