Healthcare Provider Details

I. General information

NPI: 1689828063
Provider Name (Legal Business Name): WILLIAM L. TELLEZ, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 CORTE CORRIDA
CAMARILLO CA
93010-7413
US

IV. Provider business mailing address

11999 SAN VICENTE BLVD STE 440
LOS ANGELES CA
90049-5042
US

V. Phone/Fax

Practice location:
  • Phone: 805-482-2029
  • Fax:
Mailing address:
  • Phone: 310-471-5852
  • Fax: 310-472-9582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM L. TELLEZ
Title or Position: OWNER
Credential: M.D.
Phone: 805-482-2029