Provider Demographics
NPI:1548357890
Name:SILVA, TYRAH M
Entity type:Individual
Prefix:
First Name:TYRAH
Middle Name:M
Last Name:SILVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24710 GOLD STAR DR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-4956
Mailing Address - Country:US
Mailing Address - Phone:206-372-6742
Mailing Address - Fax:
Practice Address - Street 1:180 E 4TH ST
Practice Address - Street 2:# C
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570
Practice Address - Country:US
Practice Address - Phone:951-943-8899
Practice Address - Fax:951-943-4598
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17525208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics