MEDICARE: MRS. ESPERANZA TELLES L.M.T.

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	174400000X	Specialist	1377	NM

General Provider Information

NPI Number	:	1538399605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ESPERANZA TELLES L.M.T.

Provider Business Mailing Address
First Line	:	4784 SAROMI LN
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-6806
Country	:	US
Telephone Number	:	575-640-6926
Fax Number	:	575-525-3703

Provider Business Practice Location Address
First Line	:	210 W LAS CRUCES AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-1804
Country	:	US
Telephone Number	:	575-525-3700
Fax Number	:	575-525-3703

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

Provider Enumeration Date	:	07/22/2009
Last Update Date	:	07/22/2009

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