Organization
TRESSES ETC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RYAN MICHAEL TYISKA (PARTNER)
(213) 219-5202
Entity
Organization
Contact information
Practice address
5740 KIYOT WAY, PLAYA VISTA, CA 90094-2102
(213) 219-5202
Mailing address
5740 KIYOT WAY, PLAYA VISTA, CA 90094-2102
(213) 219-5202
Taxonomy
Speciality
Code
Description
License number
State
261QR0800X
Recovery Care Clinic/Center
Primary
—
—
Other
Enumeration date
11/01/2010
Last updated
11/01/2010
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