Provider Demographics
NPI:1083243125
Name:TORRICO, TYLER J (MD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:J
Last Name:TORRICO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-4018
Mailing Address - Country:US
Mailing Address - Phone:661-326-2237
Mailing Address - Fax:661-861-7682
Practice Address - Street 1:1700 MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-4018
Practice Address - Country:US
Practice Address - Phone:661-326-2237
Practice Address - Fax:661-861-7682
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012780372084P0800X
MDD00970322084P0800X
CAA1809992084P0800X
390200000X
DCMD2100115732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program