MEDICARE: TERI LYNN KUNIN-RIDA MD

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	207Q00000X	Family Medicine Physician	G080071	CA
2	207Q00000X	Family Medicine Physician	G80071	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1071263358	OTHER		AMERICAN BOARD OF FAMILY MEDICINE

General Provider Information

NPI Number	:	1265580112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERI LYNN KUNIN-RIDA MD

Provider Business Mailing Address
First Line	:	4060 FAIRMOUNT AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-1608
Country	:	US
Telephone Number	:	619-280-4213
Fax Number	:	619-280-3545

Provider Business Practice Location Address
First Line	:	165 S 1ST ST
Second Line	:	FAMILY PRACTICE
City	:	EL CAJON
State	:	CA
Zip	:	92019-4795
Country	:	US
Telephone Number	:	619-312-0347
Fax Number	:	619-749-5480

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	03/30/2023

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