Provider Demographics
NPI:1033885660
Name:DELEO, TYLER MICHAEL (CPO)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:MICHAEL
Last Name:DELEO
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4135 S POWER RD STE 127
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-3627
Mailing Address - Country:US
Mailing Address - Phone:520-485-7895
Mailing Address - Fax:888-901-1129
Practice Address - Street 1:4135 S POWER RD STE 127
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-3627
Practice Address - Country:US
Practice Address - Phone:520-485-7895
Practice Address - Fax:888-901-1129
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No335E00000XSuppliersProsthetic/Orthotic Supplier