Provider Demographics
NPI:1164669784
Name:TELLERIA, ANA M (DENTAL ASSISTANT)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:M
Last Name:TELLERIA
Suffix:
Gender:F
Credentials:DENTAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N EVERGREEN AVE
Mailing Address - Street 2:APT 224
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033
Mailing Address - Country:US
Mailing Address - Phone:323-495-8841
Mailing Address - Fax:
Practice Address - Street 1:5162 E WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022
Practice Address - Country:US
Practice Address - Phone:323-415-6161
Practice Address - Fax:323-416-0675
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant