MEDICARE: TELEHEALTH CLINICAL SERVICES

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	332900000X	Non-Pharmacy Dispensing Site		CA

General Provider Information

NPI Number	:	1881058345
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TELEHEALTH CLINICAL SERVICES

Provider Business Mailing Address
First Line	:	6088 BOUNTY ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-2942
Country	:	US
Telephone Number	:	619-204-6232
Fax Number	:

Provider Business Practice Location Address
First Line	:	6088 BOUNTY ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-2942
Country	:	US
Telephone Number	:	619-204-6232
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. JOHN LEASAU
Credential	:
Telephone Number	:	619-204-6232

Provider Enumeration Date	:	04/11/2016
Last Update Date	:	07/21/2022

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