Individual
TYLO BOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1251 TANNEHILL DR, MANTECA, CA 95337-8034
(209) 629-6002
Mailing address
1251 TANNEHILL DR, MANTECA, CA 95337-8034
(209) 629-6002
Taxonomy
Speciality
Code
Description
License number
State
246RP1900X
Phlebotomy Technician
Primary
—
—
Other
Enumeration date
07/13/2022
Last updated
07/13/2022
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