Military Health Care Provider (Independent Duty Corpsman)

Address: 2464 Fenton Pkwy Apt 308, San Diego, CA 92108-6704

TINSAE TEKLEAB (NPI# 1780274456) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1780274456
Entity Type Individual
Gender Male
Practice Address 2464 Fenton Pkwy Apt 308
San Diego
CA 92108-6704
Practice Telephone 7604702536
Mailing Address 2464 Fenton Pkwy Apt 308
San Diego
CA 92108-6704
Mailing Telephone 7604702536
Certification Date 2021-01-26
Enumeration Date 2021-01-26
Last Update Date 2021-01-26
Is Sole Proprietor N


Primary Taxonomy Code Classification Taxonomy Group License Number License State Taxonomy Group
Y 1710I1002X Military Health Care Provider
Specialization: Independent Duty Corpsman
Other Service Providers

Office Location

Street Address 2464 FENTON PKWY APT 308
State CA
Zip Code 92108-6704

Providers in the same zip code prefix

NPI Name Taxonomy Address Enumeration
1831780071 Barbara Bekins Behavior Technician 5333 Mission Center Road Ste 110, San Diego, CA 92108 2021-01-31
1952902801 Keri Castaneda Behavior Technician 025 Camino Del Rio South Suite 101, San Diego, CA 92108 2020-11-06
1457963738 Diyana Giorgees Case Manager/Care Coordinator 5005 Texas Street, St. 203, San Diego, CA 92108 2020-08-19
1780211896 Lori Mildred Jerman Marriage & Family Therapist Healthy Minds Counseling Services, 1455 Frazee Road, Suite 880, San Diego, CA 92108 2020-03-26
1285260737 Demetrius Anderson Counselor · Mental Health Telecare Corporation Ihot, 1660 Hotel Circle North, Suite 101, San Deigo, CA 92108 2020-03-17
1033742465 Dasc Medical Inc Durable Medical Equipment & Medical Supplies 5520 Gill Village Way, 907, San Diego, CA 92108 2020-02-13
1508401092 Chanda Denee Kizer Marriage & Family Therapist 3517 Camino Del Rio N, Suite 407, San Diego, CA 92108 2019-11-08
1225695562 Jenna Rose Shurer · Jenna Rose Titko Nurse Practitioner · Family 5030 Camino De La Siesla Ste 106, San Diego, CA 92108 2019-05-22
1952967812 Martha Kebede Mekonen Chiropractor 2667 Camino Del Rio South, Suite #313, San Diego, CA 92108 2019-05-16
1053886135 Andrea Jiselly Munoz Behavior Technician 3505 Camino Del Rio South, Suite 200, San Diego, CA 92108 2018-10-04
Find all providers in zip 92108

Taxonomy Information

Taxonomy Code 1710I1002X
Grouping Other Service Providers
Classification Military Health Care Provider
Specialization Independent Duty Corpsman

Taxonomy Definition

A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals.
Notes: Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1124619861 Keoky Delapena 14101 Farenholt Avenue Bldg 14, San Diego, CA 92134-5291 2021-01-26
1801492145 Felicia Leanna Roberts 2267 Reed Ave, San Diego, CA 92109-5628 2020-12-10
1720684319 Brandon Young 3401 Farenholt Ave Building 14, San Diego, CA 92134-0001 2020-12-08
1770180648 Darius Lee Sean Woods 6033 Sandy Shore Ct, San Diego, CA 92139-1014 2020-10-05
1174130744 Daniel Carrera 2645 W Canyon Ave Apt 450, San Diego, CA 92123-4700 2020-09-28
1316551740 Kyle Bode Francis 3149 Murray Ridge Rd, San Diego, CA 92123-2917 2020-09-02
1255945069 Jeremy Lee 509 Dennery Rd Apt 145, San Diego, CA 92154-8542 2020-08-31
1013520667 Rashaad Brown 4454 Cherokee Ave Apt 2, San Diego, CA 92116-3611 2020-08-24
1932711934 Alvaro Daniel Macias 8685 Rio San Diego Dr Apt 4344, San Diego, CA 92108-6560 2020-08-20
1255943635 Stephon Peyton Frost 2654 Mendonca Dr, San Diego, CA 92110-4263 2020-08-18
Find all providers in SAN DIEGO


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Zip Code 92108

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Dataset Information

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.