Individual
TYLER AKIRA ICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4300 E FLAMINGO AVE, NAMPA, ID 83687-3138
(714) 318-0439
Mailing address
928 S AUSTIN WAY, ANAHEIM, CA 92808-2350
(714) 318-0439
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M-17236
ID
208M00000X
Hospitalist Physician
M-17236
ID
Other
Enumeration date
04/02/2020
Last updated
11/03/2023
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