Provider Demographics
NPI:1245063767
Name:YOUNGBLOOD, TYLER (BA)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:YOUNGBLOOD
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 S K ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-5416
Mailing Address - Country:US
Mailing Address - Phone:559-688-2043
Mailing Address - Fax:
Practice Address - Street 1:327 S K ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-5416
Practice Address - Country:US
Practice Address - Phone:559-688-2043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker