JOEL TETZLAFF (NPI# 1164621074) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164621074 |
| Entity Type | Individual |
| Full Name | JOEL TETZLAFF |
| Credential | PA |
| Practice Address |
2720 N Harbor Blvd Suite 130 Fullerton CA 92835-2609 |
| Mailing Address |
Dept La21190 Pasadena CA 91185-1190 |
| Practice Telephone | 7144496230 |
| Practice Fax Number | 7144491773 |
| Mailing Telephone | 7144494800 |
| Mailing Fax Number | 7144494956 |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2007-07-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA18035 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | LICENSE | PA18035 | 01 |
| Street Address |
2720 N HARBOR BLVD SUITE 130 |
| City | FULLERTON |
| State | CA |
| Zip Code | 92835-2609 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588664916 | Jonathan Anderson | Family Medicine | 2720 N Harbor Blvd, Suite 200, Fullerton, CA 92835 | 2005-07-28 |
| 1154936011 | Advanced Skincare, A Professional Corp. | Physician Assistant | 2720 N Harbor Blvd, Fullerton, CA 92835-2609 | 2020-09-08 |
| 1629314521 | Darshana Patel | Physician Assistant | 2720 N Harbor Blvd, Ste 130, Fullerton, CA 92835-2609 | 2012-12-20 |
| 1679879696 | St Jude Hospital Yorba Linda | Durable Medical Equipment & Medical Supplies | 2720 N Harbor Blvd, Suite 200, Fullerton, CA 92835-2609 | 2011-02-09 |
| 1588960504 | St Jude Hospital Yorba Linda | Durable Medical Equipment & Medical Supplies | 2720 N Harbor Blvd, Suite 220, Fullerton, CA 92835-2609 | 2011-02-09 |
| 1396041315 | St Jude Hospital Yorba Linda | Durable Medical Equipment & Medical Supplies | 2720 N Harbor Blvd, Suite 300, Fullerton, CA 92835-2609 | 2011-02-09 |
| 1023314044 | St Jude Hospital Yorba Linda | Durable Medical Equipment & Medical Supplies | 2720 N Harbor Blvd, Suite 130, Fullerton, CA 92835-2609 | 2011-02-09 |
| 1619273059 | St Jude Hospital Yorba Linda | Durable Medical Equipment & Medical Supplies | 2720 N Harbor Blvd, Suite 100, Fullerton, CA 92835-2609 | 2011-02-02 |
| 1538488101 | Bo Song | Physician Assistant | 2720 N Harbor Blvd, Suite 130, Fullerton, CA 92835-2609 | 2010-05-21 |
| 1023272309 | Khaled Mahmoud Hassan | Dermatology | 2720 N Harbor Blvd, Ste 220, Fullerton, CA 92835-2609 | 2008-07-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538774302 | Natalie Baugh | Nutritionist | 333 W Bastanchury Rd 110, Fullerton, CA 92835 | 2020-09-09 |
| 1073127098 | Cecile Mae Sam | Physical Therapist | 2932 Clover Ct, Fullerton, CA 92835 | 2020-09-08 |
| 1861966087 | Kimson F Johnston | Marriage & Family Therapist | 1370 Brea Blvd Suite 210, Fullerton, CA 92835 | 2019-01-22 |
| 1134636327 | Michelle Harriman, Psychologist - A Professional Corporation | Psychologist | 1440 N Harbor Blvd Ste 808, Fullerton, CA 92835 | 2018-01-09 |
| 1659818631 | Jacqueline Rene Miller | Specialist/Technologist | 2610 Associated Rd, Apt A4, Fullerton, CA 92835 | 2017-01-27 |
| 1912361106 | John Nathaniel Alvarez | Psychiatry & Neurology | 401 E Imperial Highway, Fullerton, CA 92835 | 2016-04-13 |
| 1083075030 | Advance Recovery Solution, LLC | Substance Abuse Rehabilitation Facility | 3744 N Hermosa Pl, Fullerton, CA 92835 | 2016-03-17 |
| 1467817981 | Michele Ledesma | Physical Therapy Assistant | 2800 N. Harbor Blvd., Fullerton, CA 92835 | 2015-12-29 |
| 1467820571 | Jonghan Kang | Acupuncturist | 1321 N Harbor Blvd Ste 205, Fullerton, CA 92835 | 2015-09-04 |
| 1265840987 | Allison Leigh Kennedy | Physician Assistant | 100 Laguna Rd Ste 208, Fullerton, CA 92835 | 2014-07-25 |
| Find all providers in zip 92835 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881234714 | Erica Marie Shepard | Physician Assistant | 909 Oakdale Ave, Fullerton, CA 92831-2912 | 2020-01-08 |
| 1154889327 | Rose-ann Guevarra | Physician Assistant | 735 W Hill Ave, Fullerton, CA 92832-2819 | 2019-03-06 |
| 1033694054 | Nida Mansoor | Physician Assistant | 1565 S Harbor Blvd, Fullerton, CA 92832-3402 | 2018-09-25 |
| 1467804112 | Megan Kyoko Schulz | Physician Assistant | 3251 Santa Monica Ave, Fullerton, CA 92835-1703 | 2016-07-06 |
| 1104283183 | Patricia Buchholtz | Physician Assistant | 808 N Tamarack Dr, Fullerton, CA 92832-2137 | 2016-01-21 |
| 1265840987 | Allison Leigh Kennedy | Physician Assistant | 100 Laguna Rd Ste 208, Fullerton, CA 92835 | 2014-07-25 |
| 1114343886 | Silvia Albertini | Physician Assistant | 300 W Las Palmas Dr, Fullerton, CA 92835-1534 | 2014-03-05 |
| 1629322110 | Maria Mehaela Tiu | Physician Assistant | 2720 N Harbor Blvd Ste 130, Fullerton, CA 92835-2625 | 2012-11-05 |
| 1649535600 | David Chong | Physician Assistant | 1319 Ponderosa Ave, Fullerton, CA 92835-2034 | 2012-07-05 |
| 1851615371 | Bung Joo Choi | Physician Assistant | 1117 Klose Ln, Fullerton, CA 92833-5777 | 2010-03-26 |
| Find all providers in FULLERTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.