Provider Demographics
NPI:1245391432
Name:TELLEZ, RACHEL WALLACE (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:WALLACE
Last Name:TELLEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RACHEL
Other - Middle Name:ELIZABETH
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3714 FARMSTEAD PATH
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-6723
Mailing Address - Country:US
Mailing Address - Phone:202-316-5633
Mailing Address - Fax:651-222-1305
Practice Address - Street 1:153 CESAR CHAVEZ ST
Practice Address - Street 2:
Practice Address - City:W. ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-2226
Practice Address - Country:US
Practice Address - Phone:651-222-1816
Practice Address - Fax:651-222-1305
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN56008208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics