Provider Demographics
NPI:1053316471
Name:TELLEZ, MARIA EMILIA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:EMILIA
Last Name:TELLEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10623 BELLAIRE BLVD STE C280
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-5242
Mailing Address - Country:US
Mailing Address - Phone:713-500-5666
Mailing Address - Fax:713-500-0527
Practice Address - Street 1:10623 BELLAIRE BLVD STE C280
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-5242
Practice Address - Country:US
Practice Address - Phone:713-500-5666
Practice Address - Fax:713-500-0527
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2023-02-05
Deactivation Date:2006-03-30
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
TXL4753208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153808402Medicaid
TXH71708Medicare UPIN