MEDICARE: DANA TELLER M.D

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	207V00000X	Obstetrics & Gynecology Physician	A175895	CA

General Provider Information

NPI Number	:	1295154607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA TELLER M.D

Provider Business Mailing Address
First Line	:	9339 GENESEE AVE STE 220
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-2196
Country	:	US
Telephone Number	:	858-455-1248
Fax Number	:	858-455-5461

Provider Business Practice Location Address
First Line	:	9339 GENESEE AVE STE 220
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-2196
Country	:	US
Telephone Number	:	858-455-1248
Fax Number	:	858-455-5461

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

Provider Enumeration Date	:	04/14/2014
Last Update Date	:	02/06/2023

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Directions to “ DANA TELLER M.D” Practice Location

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