Healthcare Provider Details

I. General information

NPI: 1184987281
Provider Name (Legal Business Name): TELLO & ASSOCIATES, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 06/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E LAS TUNAS DR
SAN GABRIEL CA
91776-1484
US

IV. Provider business mailing address

222 E LAS TUNAS DR
SAN GABRIEL CA
91776-1484
US

V. Phone/Fax

Practice location:
  • Phone: 626-320-1317
  • Fax:
Mailing address:
  • Phone: 626-320-1317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. RUTH TELLO-DI LEVA
Title or Position: CLINICAL DIRECTOR
Credential: MS, BCBA
Phone: 626-320-1317