Individual
DR. EDWARDO TELLEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
63350
CA
208000000X
Pediatrics Physician
G63350
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G63350
BLUE SHIELD
CA
05
—
00G633500
—
CA
05
—
00G63350C
—
CA
01
—
370020277
MEDICARE RAILROAD
CA
Enumeration date
08/01/2006
Last updated
07/25/2016
Update your record
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