Provider Demographics
NPI:1891450789
Name:KINCHERLOW, TYLA CHANTEL
Entity Type:Individual
Prefix:MS
First Name:TYLA
Middle Name:CHANTEL
Last Name:KINCHERLOW
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TYLA
Other - Middle Name:CHANTEL
Other - Last Name:KINCHERLOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:33999 TUSCAN CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-5639
Mailing Address - Country:US
Mailing Address - Phone:951-252-4123
Mailing Address - Fax:
Practice Address - Street 1:33999 TUSCAN CREEK WAY
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-5639
Practice Address - Country:US
Practice Address - Phone:951-252-4123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA331880898310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility