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NPI Code Detail

MEDICARE: TINA MARIE MITTERLING PA-C

MEDICARE: TINA MARIE MITTERLING PA-C
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
1363A00000XPhysician Assistant67090CA
2363AM0700XMedical Physician Assistant1235SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427242239
Entity Type Code : Individual
Provider Name (Legal Business Name) : TINA MARIE MITTERLING PA-C
Provider Business Mailing Address
First Line : 823 GATEWAY CENTER WAY
Second Line :
City : SAN DIEGO
State : CA
Zip : 92102-4541
Country : US
Telephone Number : 619-515-2300
Fax Number :
Provider Business Practice Location Address
First Line : 3705 MISSION BLVD
Second Line :
City : SAN DIEGO
State : CA
Zip : 92109-7104
Country : US
Telephone Number : 619-515-2444
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2007
Last Update Date : 10/20/2025

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Directions to “ TINA MARIE MITTERLING PA-C” Practice Location

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