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Individual
DR. JESSE TELLEZ HERNANDEZ
Active
Individual
DR. JESSE TELLEZ HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP-1663A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11948571-4405
PROFESSIONAL LICENSE
UT
01
—
NP-1663A
PROFESSIONAL LICENSE
ID
Enumeration date
12/10/2015
Last updated
03/30/2022
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