Search › California › 103TC0700X
Tyler Peterson
NPI 1558017822 · on the registry since 2022
Practice
- Address
- 4001 Hwy 104
Ione, CA 95640 - Phone
- (209) 274-4911
- Organisation at this address
- Corrections And Rehabilitation-Headquarters
Corrections And Rehabilitation-HeadquartersInferred from a shared address, not stated in the registry. - Clinicians at this address
- 12
Registry record
- Primary taxonomy
- 103TC0700X
103TC0700X
- Also registered as
- 390200000X
- Licence states on file
- CA
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2023-04-26
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in California