MEDICARE: MRS. CYNTHIA SOLORIO TELLO MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	95910	CA

General Provider Information

NPI Number	:	1144985011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CYNTHIA SOLORIO TELLO MSW

Provider Business Mailing Address
First Line	:	24700 BOMBAY AVE
Second Line	:
City	:	WILMINGTON
State	:	CA
Zip	:	90744-1111
Country	:	US
Telephone Number	:	310-339-3931
Fax Number	:

Provider Business Practice Location Address
First Line	:	8040 ORTONVILLE RD
Second Line	:
City	:	CLARKSTON
State	:	MI
Zip	:	48348-4468
Country	:	US
Telephone Number	:	248-989-5432
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2021
Last Update Date	:	11/04/2021

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