Provider Demographics
NPI:1568495703
Name:TIZNADO-GARCIA, ERNESTO (MD)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:
Last Name:TIZNADO-GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 3RD AVE
Mailing Address - Street 2:SUITE L
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-5882
Mailing Address - Country:US
Mailing Address - Phone:619-425-8901
Mailing Address - Fax:619-425-8902
Practice Address - Street 1:1635 3RD AVE
Practice Address - Street 2:SUITE L
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-5882
Practice Address - Country:US
Practice Address - Phone:619-425-8901
Practice Address - Fax:619-425-8902
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA451832080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A451831Medicaid