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General NPI Number Information
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NPI Number | 1154918456
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Entity Type | Individual
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Provider Name | LAURA ALICIA TELLEZ NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 12/22/2020
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Last Update Date | 01/09/2023
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Provider Practice Location Address
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Address Line | 7130 N MILLBROOK AVE
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City | FRESNO
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State | CA
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Zip | 93720-3347
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Country | US
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Telephone | 559-326-1222
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Fax | 559-326-1320
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Provider Business Mailing Address
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Address Line | 7130 N MILLBROOK AVE
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City | FRESNO
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State | CA
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Zip | 93720-3347
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Country | US
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Telephone | 559-326-1222
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Fax | 559-326-1230
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95016235
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License Number State | CA
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