Individual provider · Type 1 NPI

Djian-Luke Ty

Student in an Organized Health Care Education/Training Program · Las Vegas, NV

NPI number 1558210641 Active

Practice location

1800 W Charleston Blvd
Las Vegas, NV 89102-2386

Call (702) 774-5134 Map

Mailing address

1856 Jupiter Hills Rd
Corona, CA 92883-0660

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1558210641

Djian-Luke Ty's National Provider Identifier is 1558210641, issued on Jan 22, 2026. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Las Vegas, NV. The record was last updated on Jan 22, 2026.