Provider Demographics
NPI:1528080041
Name:TETTEH, NII ARYEE E (MD)
Entity type:Individual
Prefix:
First Name:NII ARYEE
Middle Name:E
Last Name:TETTEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 4TH AVE
Mailing Address - Street 2:STE 10
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910
Mailing Address - Country:US
Mailing Address - Phone:619-426-8222
Mailing Address - Fax:619-426-9051
Practice Address - Street 1:340 4TH AVE
Practice Address - Street 2:STE 10
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910
Practice Address - Country:US
Practice Address - Phone:619-426-8222
Practice Address - Fax:619-426-9051
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76579207R00000X, 208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH95045Medicare UPIN
CAA76579Medicare ID - Type Unspecified