| Doctor Name: | MR. JASON THOMAS WILLIAM TETZLAFF |
| NPI Number: | 1043247091 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | IDC |
| License Number: | 2099 |
| Business Practice Address: | 3402 Tarawa Rd Sbt-12 San Diego, CA - 921555176 |
| Business Phone Number: | 6194375539 |
| Business Fax Number: | 6194372955 |
| Mailing Address: | 4742 Gainard Way, SAN DIEGO |
| State: | CA |
| Postal Code: | 921242913 |
| Phone Number: | 6194368538 |
| Fax Number: | 6194372955 |
| NPI Enumeration Date: | 06/26/2006 |
| NPI Last Update Date: | 04/22/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171000000X |
| License Number: | 2099 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Military Health Care Provider |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |