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Individual
DR. JONATHAN TIEFENBRUN
Active
Individual
DR. JONATHAN TIEFENBRUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085U0001X
Diagnostic Ultrasound Physician
Primary
B18861
CA
208600000X
Surgery Physician
G85951
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WG85951A
SO CA MEDICARE PTAN
CA
Enumeration date
06/20/2005
Last updated
09/18/2015
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