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General NPI Number Information
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NPI Number | 1013129659
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Entity Type | Individual
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Provider Name | CINDY ELLEN TETZLAFF PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 09/17/2019
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Provider Practice Location Address
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Address Line | 10650 SIERRA AVE STE B
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City | FONTANA
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State | CA
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Zip | 92337-7664
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Country | US
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Telephone | 909-550-3320
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Fax |
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Provider Business Mailing Address
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Address Line | 6790 FAIRCHILD ST
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City | FONTANA
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State | CA
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Zip | 92336-4192
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Country | US
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Telephone | 909-512-6612
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 11644
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3473
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License Number State | AZ
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