Provider Demographics
NPI:1598533416
Name:TELLEZ, GILMA NATALIE
Entity Type:Individual
Prefix:
First Name:GILMA
Middle Name:NATALIE
Last Name:TELLEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3487 NW 22ND AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-5321
Mailing Address - Country:US
Mailing Address - Phone:954-536-1063
Mailing Address - Fax:
Practice Address - Street 1:3487 NW 22ND AVE APT 207
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-5321
Practice Address - Country:US
Practice Address - Phone:954-536-1063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLT420294039220103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst