Healthcare Provider Details

I. General information

NPI: 1790970648
Provider Name (Legal Business Name): BERNARD RICHARD TEGTMEIER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 DUARTE RD
DUARTE CA
91010-3012
US

IV. Provider business mailing address

4312 FIR AVE
SEAL BEACH CA
90740-2905
US

V. Phone/Fax

Practice location:
  • Phone: 626-301-8225
  • Fax: 626-301-8954
Mailing address:
  • Phone: 562-493-6132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License NumberDRI39
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: