Individual
DOMINIC TELLEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1600 PHTORPE ROAD, LAS CRUCES, NM 88012
(575) 526-6200
(575) 526-2266
Mailing address
PO BOX 370, HATCH, NM 87937-0370
(575) 267-3280
(575) 267-1747
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2009-0029
NM
Other
Enumeration date
09/23/2009
Last updated
09/23/2009
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