Provider Demographics
NPI:1932417474
Name:PEHLKE, TYLER WILLIAM
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:WILLIAM
Last Name:PEHLKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 WOODSIDE LN E
Mailing Address - Street 2:#2
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-4345
Mailing Address - Country:US
Mailing Address - Phone:530-400-9697
Mailing Address - Fax:
Practice Address - Street 1:1400 N A ST
Practice Address - Street 2:BUILDING A
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-0612
Practice Address - Country:US
Practice Address - Phone:916-440-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program