Provider Demographics
NPI:1538399605
Name:TELLES, ESPERANZA (LMT)
Entity type:Individual
Prefix:MRS
First Name:ESPERANZA
Middle Name:
Last Name:TELLES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4784 SAROMI LN
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-6806
Mailing Address - Country:US
Mailing Address - Phone:575-640-6926
Mailing Address - Fax:575-525-3703
Practice Address - Street 1:210 W LAS CRUCES AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-1804
Practice Address - Country:US
Practice Address - Phone:575-525-3700
Practice Address - Fax:575-525-3703
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1377174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist