MEDICARE: SUSIE TELLEZ

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	163WS0200X	School Registered Nurse	710624	CA

General Provider Information

NPI Number	:	1285512715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSIE TELLEZ

Provider Business Mailing Address
First Line	:	133 MISSION ST STE 100
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-3747
Country	:	US
Telephone Number	:	831-429-3410
Fax Number	:

Provider Business Practice Location Address
First Line	:	133 MISSION ST STE 100
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-3747
Country	:	US
Telephone Number	:	831-429-3410
Fax Number	:

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

Provider Enumeration Date	:	08/22/2025
Last Update Date	:	08/22/2025

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Directions to “ SUSIE TELLEZ ” Practice Location

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