Provider Demographics
NPI:1467171272
Name:US TELEMEDICINE LLC
Entity Type:Organization
Organization Name:US TELEMEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR AND OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:SANTOS
Authorized Official - Last Name:AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-997-2639
Mailing Address - Street 1:309 RED SUN DR # D1
Mailing Address - Street 2:
Mailing Address - City:CHAPARRAL
Mailing Address - State:NM
Mailing Address - Zip Code:88081-7966
Mailing Address - Country:US
Mailing Address - Phone:575-228-7787
Mailing Address - Fax:
Practice Address - Street 1:309 RED SUN DR # D1
Practice Address - Street 2:
Practice Address - City:CHAPARRAL
Practice Address - State:NM
Practice Address - Zip Code:88081-7966
Practice Address - Country:US
Practice Address - Phone:575-228-7787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1760722342Medicaid