MEDICARE: YVONNE TELLES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247200000X	Other Technician

General Provider Information

NPI Number	:	1346966546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVONNE TELLES

Provider Business Mailing Address
First Line	:	7108 S KANNER HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-7462
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

Provider Business Practice Location Address
First Line	:	8885 HARVEST HILL WAY # 1113
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-1460
Country	:	US
Telephone Number	:	916-223-2364
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2022
Last Update Date	:	10/18/2022

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Directions to “ YVONNE TELLES ” Practice Location

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