Provider Demographics
NPI:1881878023
Name:KLARISTENFELD, TESS FABRICK (MD,MPH)
Entity type:Individual
Prefix:DR
First Name:TESS
Middle Name:FABRICK
Last Name:KLARISTENFELD
Suffix:
Gender:F
Credentials:MD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 DEL MAR HEIGHTS RD # 273
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2199
Mailing Address - Country:US
Mailing Address - Phone:858-633-3751
Mailing Address - Fax:
Practice Address - Street 1:3525 DEL MAR HEIGHTS RD # 273
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2199
Practice Address - Country:US
Practice Address - Phone:858-633-3751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101806207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine