Provider Demographics
NPI:1295942001
Name:TELLES, ROBERT L (MS RAS)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
Last Name:TELLES
Suffix:
Gender:M
Credentials:MS RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:320 CALDECOTT LN UNIT 314
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-2429
Mailing Address - Country:US
Mailing Address - Phone:510-374-3337
Mailing Address - Fax:510-374-3328
Practice Address - Street 1:2523 EL PORTAL DR STE 102
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3305
Practice Address - Country:US
Practice Address - Phone:510-374-3337
Practice Address - Fax:510-374-3328
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)