Healthcare Provider Details

I. General information

NPI: 1053615740
Provider Name (Legal Business Name): JOHN R. TESMAN, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 LOMA VISTA RD STE 205
VENTURA CA
93003-1582
US

IV. Provider business mailing address

9600 CUYAMACA ST SUITE 201
SANTEE CA
92071-2692
US

V. Phone/Fax

Practice location:
  • Phone: 805-652-5011
  • Fax:
Mailing address:
  • Phone: 619-258-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberG65726
License Number StateCA

VIII. Authorized Official

Name: ELENA M STEMMLER
Title or Position: BILLING MANAGER
Credential:
Phone: 619-258-6200