Provider Demographics
NPI:1598374456
Name:TYLER BASEN MD INC
Entity Type:Organization
Organization Name:TYLER BASEN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALLERGIST
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:BASEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-922-5927
Mailing Address - Street 1:3 SANTA CRUZ AISLE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-0813
Mailing Address - Country:US
Mailing Address - Phone:301-922-5927
Mailing Address - Fax:
Practice Address - Street 1:26691 PLAZA STE 170
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6396
Practice Address - Country:US
Practice Address - Phone:949-755-6414
Practice Address - Fax:339-207-0457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Single Specialty