Provider Demographics
NPI:1902320153
Name:TESLA MEDICAL GROUP
Entity Type:Organization
Organization Name:TESLA MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:PROF
Authorized Official - First Name:NARAYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOMMIREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-247-2510
Mailing Address - Street 1:4203 GENESEE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4950
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4203 GENESEE AVE STE 103
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-4950
Practice Address - Country:US
Practice Address - Phone:619-674-9072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-31
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty