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General NPI Number Information
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NPI Number | 1710588561
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Entity Type | Individual
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Provider Name | EVELYN TELLADO PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 11/06/2020
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | BO SABANA HOYOS SEC VILLA LAGUNA 383 ST EUGENIO MARIA DE HOSTOS
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City | VEGA ALTA
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State | PR
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Zip | 00692
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Country | US
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Telephone | 939-628-5292
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Fax |
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Provider Business Mailing Address
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Address Line | HC 83BOX 7333
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City | VEGA ALTA
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State | PR
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Zip | 00692
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Country | US
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Telephone | 939-628-5292
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 00646-PA
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License Number State | PR
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