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General NPI Number Information
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NPI Number | 1194569756
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Entity Type | Individual
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Provider Name | PRISCILLA C TELLES
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Gender | Female
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Dates
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Enumeration Date | 06/19/2024
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 9718 HARVARD ST
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City | BELLFLOWER
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State | CA
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Zip | 90706-3635
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Country | US
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Telephone | 562-925-2777
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Fax |
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Provider Business Mailing Address
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Address Line | 6666 GREEN VALLEY CIR
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City | CULVER CITY
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State | CA
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Zip | 90230-7068
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Country | US
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Telephone | 310-305-8878
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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