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General NPI Number Information
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NPI Number | 1730568163
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Entity Type | Individual
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Provider Name | MARIEL TELMO DPM
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Gender | Female
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Dates
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Enumeration Date | 05/18/2015
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Last Update Date | 01/24/2019
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Provider Practice Location Address
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Address Line | 250 NORTHGATE DR
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City | MANTECA
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State | CA
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Zip | 95336-3161
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Country | US
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Telephone | 209-239-5299
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Fax | 877-436-1494
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Provider Business Mailing Address
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Address Line | 1910 CUSTOMER CARE WAY
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City | ATWATER
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State | CA
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Zip | 95301-5167
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Country | US
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Telephone | 209-384-6542
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Fax | 855-202-9336
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | DPM5366
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License Number State | CA
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