MEDICARE: DR. TESS FABRICK KLARISTENFELD MD,MPH

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	207P00000X	Emergency Medicine Physician	A101806	CA

General Provider Information

NPI Number	:	1881878023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TESS FABRICK KLARISTENFELD MD,MPH

Provider Business Mailing Address
First Line	:	3525 DEL MAR HEIGHTS RD # 273
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2199
Country	:	US
Telephone Number	:	858-633-3751
Fax Number	:

Provider Business Practice Location Address
First Line	:	3525 DEL MAR HEIGHTS RD # 273
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2199
Country	:	US
Telephone Number	:	858-633-3751
Fax Number	:

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

Provider Enumeration Date	:	12/24/2007
Last Update Date	:	06/19/2013

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