Provider Demographics
NPI:1386412419
Name:BOONE, TYLER LEE I
Entity type:Individual
Prefix:MR
First Name:TYLER
Middle Name:LEE
Last Name:BOONE
Suffix:I
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 1:432 W GUAVA ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-3437
Mailing Address - Country:US
Mailing Address - Phone:843-609-1140
Mailing Address - Fax:
Practice Address - Street 1:432 W GUAVA ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-3437
Practice Address - Country:US
Practice Address - Phone:843-609-1140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst