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General NPI Number Information
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NPI Number | 1063985687
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Entity Type | Organization
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Legal Business Name | TELELIF LLC
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Dates
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Enumeration Date | 01/07/2019
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Last Update Date | 01/07/2019
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Provider Practice Location Address
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Address Line | 10817 W HIGHWAY 71
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City | AUSTIN
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State | TX
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Zip | 78735-9609
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Country | US
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Telephone | 512-415-0693
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Fax |
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Provider Business Mailing Address
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Address Line | 10817 W HIGHWAY 71
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City | AUSTIN
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State | TX
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Zip | 78735-9609
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Country | US
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Telephone | 512-415-0693
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | JUSTIN TODD BAKER
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Credential |
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Telephone | 832-799-2295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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