Provider Demographics
NPI:1003843335
Name:CETEL, MINDY B (MD)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:B
Last Name:CETEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6725 MESA RIDGE RD
Mailing Address - Street 2:SUITE 224
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2923
Mailing Address - Country:US
Mailing Address - Phone:858-224-1866
Mailing Address - Fax:858-224-1867
Practice Address - Street 1:6725 MESA RIDGE RD
Practice Address - Street 2:SUITE 224
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2923
Practice Address - Country:US
Practice Address - Phone:858-224-1866
Practice Address - Fax:858-224-1867
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62985174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFG622ZOtherINDIVIDUAL PTAN LOS ANGELES
CAW14362BOtherGRP PTAN
CA00G629850Medicaid
CAW14362OtherGRP PTAN
CAW14362AMedicare PIN
CAW14362OtherGRP PTAN
CAE98133Medicare UPIN
CAFG622ZOtherINDIVIDUAL PTAN LOS ANGELES