Provider Demographics
NPI:1881857787
Name:LLAMAS, TELESFORO JR (PA)
Entity Type:Individual
Prefix:MR
First Name:TELESFORO
Middle Name:
Last Name:LLAMAS
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FISHER DR
Mailing Address - Street 2:APARTMENT 607
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-3666
Mailing Address - Country:US
Mailing Address - Phone:914-665-1403
Mailing Address - Fax:
Practice Address - Street 1:2 FISHER DR
Practice Address - Street 2:APARTMENT 607
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-3666
Practice Address - Country:US
Practice Address - Phone:914-665-1403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004712363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant