Jason Thomas William Tetzlaff, IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

License

2099 Issued in AZ

Practice address

3402 Tarawa Rd
SBT-12
San Diego, CA 92155-5176

Phone

(619) 437-5539

Fax

(619) 437-2955

NPI assigned

Jun 26, 2006

Last updated

Apr 22, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208822400000",
    "number": "1043247091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4742 GAINARD WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921242913",
            "telephone_number": "619-436-8538",
            "fax_number": "619-437-2955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3402 TARAWA RD",
            "address_2": "SBT-12",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921555176",
            "telephone_number": "619-437-5539",
            "fax_number": "619-437-2955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TETZLAFF",
        "first_name": "JASON",
        "middle_name": "THOMAS WILLIAM",
        "name_prefix": "Mr.",
        "credential": "IDC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-26",
        "last_updated": "2008-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": "CA",
            "license": "2099",
            "primary": false
        },
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": "AZ",
            "license": "2099",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US NAVY",
            "identifier": "2099",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brent H Testerman
• Elise M. Tetelman, PA-C, MBA
• Paige Tetreau
• Russell Tett, PHARMD
• Kallie Tettenburn, M.S., CCC-SLP
• Thomas Teubl, AUD
• Ronald J. Teufel II, MD
• Richard Tew, M.D.
• Sue Tewanarumitkul
• Summer Tewey

• Independent Duty Corpsman in San Diego, CA
• Providers in San Diego, CA by specialty
• Independent Duty Corpsman in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.