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General NPI Number Information
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NPI Number | 1912475344
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Entity Type | Individual
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Provider Name | SARA VIVIAN TELLO FNP-C
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Gender | Female
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Dates
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Enumeration Date | 11/03/2018
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Last Update Date | 11/10/2021
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Provider Practice Location Address
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Address Line | 4407 6TH ST
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City | LUBBOCK
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State | TX
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Zip | 79416-4733
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Country | US
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Telephone | 806-771-5864
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Fax | 806-771-9009
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Provider Business Mailing Address
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Address Line | 4512 93RD DR
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City | LUBBOCK
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State | TX
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Zip | 79424-5114
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Country | US
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Telephone | 806-928-1144
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Fax | 806-771-9009
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | AP139612
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP139612
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License Number State | TX
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