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NPI Code Detail

MEDICARE: DANIEL TELLEZ

MEDICARE: DANIEL TELLEZ
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
1101YM0800XMental Health CounselorIMH18991FL

General Provider Information

NPI Number : 1528687506
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL TELLEZ
Provider Business Mailing Address
First Line : 4649 PONCE DE LEON BLVD STE 404
Second Line :
City : CORAL GABLES
State : FL
Zip : 33146-2121
Country : US
Telephone Number : 786-536-9714
Fax Number : 786-536-9833
Provider Business Practice Location Address
First Line : 4649 PONCE DE LEON BLVD STE 404
Second Line :
City : CORAL GABLES
State : FL
Zip : 33146-2121
Country : US
Telephone Number : 786-536-9714
Fax Number : 786-536-9833
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2020
Last Update Date : 04/10/2020

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