Basic Information
| Provider Information | |||||||||
| NPI: | 1356379002 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TEITEL | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | F. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 505 PARNASSUS AVE. | ||||||||
| Address2: | ROOM M1305 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941430544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153534140 | ||||||||
| FaxNumber: | 4153534144 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 PARNASSUS AVE FL 2 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941432202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153532008 | ||||||||
| FaxNumber: | 4153532234 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 07/12/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | G42831 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0202X | G42831 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 00G428310 | 05 | CA | PIN | MEDICAID |