Healthcare Provider Details

I. General information

NPI: 1124267034
Provider Name (Legal Business Name): ADRIENNE ANN TESAREK OTR/L,CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2009
Last Update Date: 12/23/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WEST ARBOR DR. UCSD MEDICAL CENTER MAIL DROP 8775
SAN DIEGO CA
92103
US

IV. Provider business mailing address

17711 MARGATE ST APT 116
ENCINO CA
91316-3209
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-6530
  • Fax:
Mailing address:
  • Phone: 858-337-4596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number1874
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: