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General NPI Number Information
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NPI Number | 1336582675
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Entity Type | Individual
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Provider Name | LAURA MARIA TELLECHEA MD MPF FACOG
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Gender | Female
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Dates
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Enumeration Date | 04/16/2013
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 14546 OLD SAINT AUGUSTINE RD
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City | JACKSONVILLE
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State | FL
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Zip | 32258-5468
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Country | US
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Telephone | 904-245-1328
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Fax | 866-554-1741
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Provider Business Mailing Address
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Address Line | PO BOX 748817
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City | ATLANTA
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State | GA
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Zip | 30374-8817
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Country | US
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Telephone | 813-286-0033
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Fax | 813-282-1806
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME148727
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License Number State | FL
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