Provider Demographics
NPI:1730757766
Name:SZKLARSKI, TYLER (N/A)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:SZKLARSKI
Suffix:
Gender:M
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16947 OTSEGO ST
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316
Mailing Address - Country:US
Mailing Address - Phone:818-450-6436
Mailing Address - Fax:
Practice Address - Street 1:16947 OTSEGO ST
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3455
Practice Address - Country:US
Practice Address - Phone:818-450-6436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILXOF843051139OtherBLUECROSS BLUESHIELD
CA91508375G01070Medicaid