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Individual

DR. JONATHAN TIEFENBRUN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
8851 CENTER DR, STE 505, LA MESA, CA 91942-3017
(619) 461-3880
(619) 461-3895
Mailing address
9610 GRANITE RIDGE DR, STE B, SAN DIEGO, CA 92123-2684
(858) 810-8000
(858) 268-1911

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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