Provider Demographics
NPI:1316382500
Name:MALY, TYLER JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JAMES
Last Name:MALY
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 1:118 MED SURGE I
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92697-1019
Mailing Address - Country:US
Mailing Address - Phone:949-824-4405
Mailing Address - Fax:949-824-7454
Practice Address - Street 1:118 MED SURGE I
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92697-1019
Practice Address - Country:US
Practice Address - Phone:949-824-4405
Practice Address - Fax:949-824-7454
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA134098207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program