Healthcare Provider Details

I. General information

NPI: 1568495703
Provider Name (Legal Business Name): ERNESTO TIZNADO-GARCIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 3RD AVE SUITE L
CHULA VISTA CA
91911-5882
US

IV. Provider business mailing address

1635 3RD AVE SUITE L
CHULA VISTA CA
91911-5882
US

V. Phone/Fax

Practice location:
  • Phone: 619-425-8901
  • Fax: 619-425-8902
Mailing address:
  • Phone: 619-425-8901
  • Fax: 619-425-8902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberA45183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: