| Tyson Medical Inc | |
|
400 Mary Ave Ste 1 Calexico CA 92231-2875 | |
| (760) 592-4351 | |
| Not Available |
| Full Name | Tyson Medical Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 400 Mary Ave Ste 1, Calexico, California |
| Authorized Official Name and Position | Brian M. Tyson (OWNER) |
| Authorized Official Contact | 7605924351 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tyson Medical Inc 420 Sunflower Ct Brawley CA 92227-3243 Ph: (951) 593-2747 | Tyson Medical Inc 400 Mary Ave Ste 1 Calexico CA 92231-2875 Ph: (760) 592-4351 |
| NPI Number | 1467241570 |
|---|---|
| Provider Enumeration Date | 05/05/2025 |
| Last Update Date | 06/25/2025 |
| Certification Date | 06/25/2025 |
| Medicare PECOS PAC ID | 3072870112 |
|---|---|
| Medicare Enrollment ID | O20171128003449 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467241570 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (NU) | Primary |
| Provider Name | Brian M Tyson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346266269 PECOS PAC ID: 7517921067 Enrollment ID: I20041115001272 |
| Provider Name | George C Fareed |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720074313 PECOS PAC ID: 6709813017 Enrollment ID: I20050719000478 |
| Provider Name | James D Tankersley |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1174697551 PECOS PAC ID: 2961506530 Enrollment ID: I20070409000597 |
| Provider Name | Anthony Raymond R Yvanovich |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1841327491 PECOS PAC ID: 0446358667 Enrollment ID: I20070611000640 |
| Provider Name | Anooshirvan Bozorgmehr |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689019200 PECOS PAC ID: 9739321209 Enrollment ID: I20130813000212 |
| Provider Name | Gary J Felix |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1801296611 PECOS PAC ID: 2567788573 Enrollment ID: I20150311000663 |
| Provider Name | Jeffrey a Cronin |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1053713107 PECOS PAC ID: 8325365679 Enrollment ID: I20150325000760 |
| Provider Name | Ernest J Newton |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1942604236 PECOS PAC ID: 3779800933 Enrollment ID: I20150326002272 |
| Provider Name | Jose Navarro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710371794 PECOS PAC ID: 0749500478 Enrollment ID: I20150521000094 |
| Provider Name | David M Ortega-endahl |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1336526557 PECOS PAC ID: 1759697840 Enrollment ID: I20150903002697 |
| Provider Name | Sean P Miller |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1861847584 PECOS PAC ID: 0648559872 Enrollment ID: I20161110002599 |
| Provider Name | Gabriel Hernandez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164043782 PECOS PAC ID: 8224450481 Enrollment ID: I20200617002294 |
| Provider Name | Wesley E Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265032486 PECOS PAC ID: 9537557392 Enrollment ID: I20211027001645 |
| Provider Name | Emmanuel O. Munoz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710366489 PECOS PAC ID: 9032501069 Enrollment ID: I20220124002545 |
| Provider Name | Christina Braunworth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831794023 PECOS PAC ID: 5294114203 Enrollment ID: I20220622002122 |
| Provider Name | Fabiola Tyson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518600360 PECOS PAC ID: 0042694580 Enrollment ID: I20220831003250 |
| Provider Name | Luis Enrique Verduzco |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811456742 PECOS PAC ID: 8921483348 Enrollment ID: I20220920003403 |
| Provider Name | Emily R Heim |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1861081994 PECOS PAC ID: 9638555733 Enrollment ID: I20220927001749 |
| Provider Name | Francisco Aviles-garcia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710614771 PECOS PAC ID: 0042696056 Enrollment ID: I20220928002847 |
| Provider Name | Joel Romo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679237580 PECOS PAC ID: 3375902133 Enrollment ID: I20230711003513 |
| Provider Name | Dawn Michele Kelley-lewis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518570415 PECOS PAC ID: 9234599150 Enrollment ID: I20230724001744 |
| Provider Name | Andres Maldonado |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699189522 PECOS PAC ID: 8628431384 Enrollment ID: I20230828003329 |
| Provider Name | Daniel Diaz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831964121 PECOS PAC ID: 2860837317 Enrollment ID: I20240223003639 |
| Provider Name | Emmanuel Beltran Gutierrez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467038935 PECOS PAC ID: 5991232902 Enrollment ID: I20250102001060 |
| Provider Name | Priscilla Gutierrez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720868334 PECOS PAC ID: 9739605254 Enrollment ID: I20250428004052 |
| Provider Name | Leilina Nguyen |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1194520304 PECOS PAC ID: 4587183298 Enrollment ID: I20250527001705 |
| Provider Name | Austin John Lindley-shappet |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760361992 PECOS PAC ID: 8224529326 Enrollment ID: I20251117003206 |
| Provider Name | Jose Luis Romero |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952080624 PECOS PAC ID: 9335628270 Enrollment ID: I20260210003042 |
| Provider Name | Luis Isaac Venegas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609698711 PECOS PAC ID: 3779089453 Enrollment ID: I20260303002306 |
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