Provider Demographics
NPI:1245672112
Name:TELLEZ, ERNESTINA ANA (LVN)
Entity type:Individual
Prefix:
First Name:ERNESTINA
Middle Name:ANA
Last Name:TELLEZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:ERNESTINA
Other - Middle Name:ANA
Other - Last Name:MEZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 50954
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93031-0954
Mailing Address - Country:US
Mailing Address - Phone:805-236-8993
Mailing Address - Fax:
Practice Address - Street 1:1072 SIMON WAY
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-1429
Practice Address - Country:US
Practice Address - Phone:805-236-8993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 248996164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA96952160EOtherMEDI-CAL