Provider Demographics
NPI:1760958409
Name:TEKIN, SERA
Entity Type:Individual
Prefix:
First Name:SERA
Middle Name:
Last Name:TEKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4849 RONSON CT STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1805
Mailing Address - Country:US
Mailing Address - Phone:858-576-8181
Mailing Address - Fax:858-408-2941
Practice Address - Street 1:4849 RONSON CT STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1805
Practice Address - Country:US
Practice Address - Phone:858-576-8181
Practice Address - Fax:858-408-2941
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-21
Last Update Date:2018-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34334111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty