Provider Demographics
NPI:1376820266
Name:DYER, TRACI LEE (PA)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:LEE
Last Name:DYER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:28853 GALAXY WAY
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-3869
Mailing Address - Country:US
Mailing Address - Phone:951-852-6653
Mailing Address - Fax:951-301-3980
Practice Address - Street 1:24910 LAS BRISAS ROAD
Practice Address - Street 2:STE 105
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4010
Practice Address - Country:US
Practice Address - Phone:951-231-1385
Practice Address - Fax:866-345-3272
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2025-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA19684363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical