Most Relevant Information
Provider Data
| NPI Number: | 1003388877 |
| Provider Name: | TYJUAN VIDAL TYLER |
| Entity Type: | Individual |
| Taxonomy Code: | 3747A0650X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 12/18/2018 |
| Last Updated: | 12/18/2018 |
Provider Practice Location
2881 S VALLEY VIEW BLVD
LAS VEGAS
NV
891020100
Practice Location Phone/Fax
| Phone: | 7022539474 |
| Fax: |
Provider Mailing Location
408 HOLLAND AVE
LAS VEGAS
NV
891062631
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |