Healthcare Provider Details

I. General information

NPI: 1699279463
Provider Name (Legal Business Name): EMILIO JOSE SAO TELLEZ APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9798 SW 24TH ST
MIAMI FL
33165-7574
US

IV. Provider business mailing address

9798 SW 24TH ST
MIAMI FL
33165-7574
US

V. Phone/Fax

Practice location:
  • Phone: 305-220-3826
  • Fax: 786-219-4263
Mailing address:
  • Phone: 305-220-3826
  • Fax: 786-219-4263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11034539
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: