Provider Demographics
NPI:1952084956
Name:TELLEZ VELAZQUEZ, EDUARDO GABRIEL (SA-C)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:GABRIEL
Last Name:TELLEZ VELAZQUEZ
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 DOMINION PARK DR APT 921
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-6745
Mailing Address - Country:US
Mailing Address - Phone:346-370-8432
Mailing Address - Fax:
Practice Address - Street 1:211 DOMINION PARK DR APT 921
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-6745
Practice Address - Country:US
Practice Address - Phone:346-370-8432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant