Individual
TADDESE TEFERI DESTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
292 EUCLID AVE, SUITE 115, SAN DIEGO, CA 92114-3643
(619) 266-3332
(619) 266-6000
Mailing address
292 EUCLID AVE STE 115, SAN DIEGO, CA 92114-3629
(619) 266-3332
(619) 266-6000
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
A49164
CA
207RG0100X
Gastroenterology Physician
Primary
A49164
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A491640
—
CA
Enumeration date
10/31/2006
Last updated
12/22/2020
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