Provider Demographics
NPI:1013480649
Name:PRICE, TYLER J (MD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:J
Last Name:PRICE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4666 UTAH ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-3193
Mailing Address - Country:US
Mailing Address - Phone:858-449-2735
Mailing Address - Fax:619-532-6003
Practice Address - Street 1:BOX 555657
Practice Address - Street 2:1ST MEDICAL BATTALION 1ST MARINE LOGISTICS GROUP
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-5657
Practice Address - Country:US
Practice Address - Phone:619-752-0215
Practice Address - Fax:510-721-0968
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01084739A2084P0800X, 390200000X
CAA2007792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program