Provider Demographics
NPI:1194784785
Name:TETEF, MERRY LYNN (MD)
Entity type:Individual
Prefix:
First Name:MERRY
Middle Name:LYNN
Last Name:TETEF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24302 PASEO DE VALENCIA STE 200
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3115
Mailing Address - Country:US
Mailing Address - Phone:949-458-8252
Mailing Address - Fax:949-588-8252
Practice Address - Street 1:24302 PASEO DE VALENCIA STE 200
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3115
Practice Address - Country:US
Practice Address - Phone:949-458-8252
Practice Address - Fax:949-588-8252
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64196207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1194784785Medicaid
CAFO783ZMedicare PIN
CAW10689Medicare PIN