Provider Demographics
NPI:1659708089
Name:TELLEZ-JACQUES, KAREN DANIELLA (DO)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:DANIELLA
Last Name:TELLEZ-JACQUES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:611 MOCKSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2705
Mailing Address - Country:US
Mailing Address - Phone:704-210-5260
Mailing Address - Fax:704-210-5265
Practice Address - Street 1:612 MOCKSVILLE AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2732
Practice Address - Country:US
Practice Address - Phone:704-210-5260
Practice Address - Fax:704-210-5265
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2018-01140207R00000X, 208M00000X
NJ25MB10111900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine