Provider Demographics
NPI:1881604122
Name:TELLEZ, CECILIA MARIA (MD)
Entity type:Individual
Prefix:MS
First Name:CECILIA
Middle Name:MARIA
Last Name:TELLEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:385 CALLE DE ALEGRA STE A
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3423
Mailing Address - Country:US
Mailing Address - Phone:575-526-1105
Mailing Address - Fax:575-524-4266
Practice Address - Street 1:18424 S HWY 28
Practice Address - Street 2:
Practice Address - City:SAN MIGUEL
Practice Address - State:NM
Practice Address - Zip Code:88058
Practice Address - Country:US
Practice Address - Phone:575-233-3830
Practice Address - Fax:575-233-4542
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM20020162207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM346734703OtherMEDICARE
NM78659230Medicaid
H57956Medicare UPIN