Provider Demographics
NPI:1962836684
Name:TELLUS CLINICAL RESEARCH, INC
Entity Type:Organization
Organization Name:TELLUS CLINICAL RESEARCH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:FIDALGIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FONT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-409-2011
Mailing Address - Street 1:2500 S DOUGLAS RD
Mailing Address - Street 2:SUITE B & C
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6104
Mailing Address - Country:US
Mailing Address - Phone:786-409-2011
Mailing Address - Fax:305-271-1555
Practice Address - Street 1:2500 S DOUGLAS RD
Practice Address - Street 2:SUITE B & C
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6104
Practice Address - Country:US
Practice Address - Phone:786-409-2011
Practice Address - Fax:305-271-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization