Individual
MR. JASON THOMAS WILLIAM TETZLAFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
3402 TARAWA RD, SBT-12, SAN DIEGO, CA 92155-5176
(619) 437-5539
(619) 437-2955
Mailing address
4742 GAINARD WAY, SAN DIEGO, CA 92124-2913
(619) 436-8538
(619) 437-2955
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
2099
CA
1710I1002X
Independent Duty Corpsman
Primary
2099
AZ
174400000X
Specialist
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2099
US NAVY
AZ
Enumeration date
06/26/2006
Last updated
04/22/2008
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