Provider Demographics
NPI:1265580112
Name:KUNIN-RIDA, TERI LYNN (MD)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:LYNN
Last Name:KUNIN-RIDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:LYNN
Other - Last Name:KUNIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4060 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1608
Mailing Address - Country:US
Mailing Address - Phone:619-280-4213
Mailing Address - Fax:619-280-3545
Practice Address - Street 1:165 S 1ST ST
Practice Address - Street 2:FAMILY PRACTICE
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-4795
Practice Address - Country:US
Practice Address - Phone:619-312-0347
Practice Address - Fax:619-749-5480
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG080071207Q00000X
CAG80071207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G800710Medicaid
1071263358OtherAMERICAN BOARD OF FAMILY MEDICINE