MEDICARE: EXCELL PEDIATRICS

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	208000000X	Pediatrics Physician	L4753	TX

General Provider Information

NPI Number	:	1316215130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCELL PEDIATRICS

Provider Business Mailing Address
First Line	:	4114 N BRAESWOOD BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-2906
Country	:	US
Telephone Number	:	281-974-2967
Fax Number	:

Provider Business Practice Location Address
First Line	:	8388 W SAM HOUSTON PKWY S
Second Line	:	168
City	:	HOUSTON
State	:	TX
Zip	:	77072-5079
Country	:	US
Telephone Number	:	281-974-2967
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARIA EMILIA TELLEZ
Credential	:	MD
Telephone Number	:	281-974-2967

Provider Enumeration Date	:	12/07/2011
Last Update Date	:	12/07/2011

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Directions to “EXCELL PEDIATRICS ” Practice Location

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