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Individual

DR. EDWARDO TELLEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
16510 BLOOMFIELD AVE, CERRITOS, CA 90703-9346
(562) 229-0902
(562) 229-0952
Mailing address
75 REMITTANCE DRIVE DEPT 6008, CHICAGO, CA 60675-6008
(562) 282-1419
(562) 920-4642

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
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