Provider Demographics
NPI:1316215130
Name:EXCELL PEDIATRICS
Entity Type:Organization
Organization Name:EXCELL PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:EMILIA
Authorized Official - Last Name:TELLEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-974-2967
Mailing Address - Street 1:4114 N BRAESWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-2906
Mailing Address - Country:US
Mailing Address - Phone:281-974-2967
Mailing Address - Fax:
Practice Address - Street 1:8388 W SAM HOUSTON PKWY S
Practice Address - Street 2:168
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-5079
Practice Address - Country:US
Practice Address - Phone:281-974-2967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4753208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH71708Medicare UPIN