Provider Demographics
NPI:1982095592
Name:TELLO, AURA
Entity Type:Individual
Prefix:
First Name:AURA
Middle Name:
Last Name:TELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MONROE
Mailing Address - Street 2:101
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3628
Mailing Address - Country:US
Mailing Address - Phone:714-527-6561
Mailing Address - Fax:
Practice Address - Street 1:1 MONROE
Practice Address - Street 2:101
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-3628
Practice Address - Country:US
Practice Address - Phone:714-527-6561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)