Provider Demographics
NPI:1083445845
Name:TROTTY, TYRICO Z (SUDCC IV)
Entity type:Individual
Prefix:
First Name:TYRICO
Middle Name:Z
Last Name:TROTTY
Suffix:
Gender:M
Credentials:SUDCC IV
Other - Prefix:
Other - First Name:TYRICO
Other - Middle Name:
Other - Last Name:TYLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:570 RANCHEROS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-2963
Mailing Address - Country:US
Mailing Address - Phone:760-277-1374
Mailing Address - Fax:
Practice Address - Street 1:3340 KEMPER ST STE 105
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4907
Practice Address - Country:US
Practice Address - Phone:619-674-3302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)