MEDICARE: DR. ADLA TESSIER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A 51666	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1073144432	OTHER		AMERICAN BOARD OF FAMILY MEDICINE

General Provider Information

NPI Number	:	1013915594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADLA TESSIER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 22128
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92192-2128
Country	:	US
Telephone Number	:	619-997-8861
Fax Number	:	858-452-0152

Provider Business Practice Location Address
First Line	:	4060 FAIRMOUNT AVE
Second Line	:	FAMILY PRACTICE
City	:	SAN DIEGO
State	:	CA
Zip	:	92105
Country	:	US
Telephone Number	:	619-255-9155
Fax Number	:	619-795-9849

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	03/27/2023

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