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General NPI Number Information
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NPI Number | 1619998960
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Entity Type | Individual
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Provider Name | RICHARD W TEZAK M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 04/18/2011
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Provider Practice Location Address
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Address Line | 1441 CONSTITUTION BLVD BLDG. 200, FLOOR ONE, SUITE 103
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City | SALINAS
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State | CA
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Zip | 93906-3100
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Country | US
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Telephone | 831-755-4123
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Fax | 831-755-4123
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Provider Business Mailing Address
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Address Line | 1615 BUNKER HILL WAY SUITE 100
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City | SALINAS
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State | CA
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Zip | 93906-6013
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Country | US
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Telephone | 831-769-1304
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Fax | 831-757-0291
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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 | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | G42005
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License Number State | CA
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