Organization
SAN DIEGO NEUROLOGICAL DISORDERS
Active
Organization
SAN DIEGO NEUROLOGICAL DISORDERS
Active
Other names
Tyrone L Hardy MD
Organization subpart
No
Provider details
NPI number
Authorized official
TYRONE LESLIE HARDY MD (PRESIDENT)
(619) 464-3153
Entity
Organization
Contact information
Practice address
5565 GROSSMONT CENTER DRIVE #1-119, LA MESA, CA 91942
(619) 464-3153
(619) 464-3429
Mailing address
5565 GROSSMONT CENTER DRIVE #1-119, LA MESA, CA 91942
(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
—
ZZZ56955Z
BLUE SHIELD
—
Enumeration date
11/15/2006
Last updated
08/22/2020
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