Provider Demographics
NPI:1285463521
Name:TELLO, CHARLENA ROSE
Entity type:Individual
Prefix:
First Name:CHARLENA
Middle Name:ROSE
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 1:1560 BETTY CT
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-4405
Mailing Address - Country:US
Mailing Address - Phone:707-839-1933
Mailing Address - Fax:
Practice Address - Street 1:1560 BETTY CT
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-4405
Practice Address - Country:US
Practice Address - Phone:707-839-1933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist