Provider Demographics
NPI:1306963392
Name:COURSEAULT, TELANA MONE
Entity type:Individual
Prefix:
First Name:TELANA
Middle Name:MONE
Last Name:COURSEAULT
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 1:23314 VIDA CT
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-3216
Mailing Address - Country:US
Mailing Address - Phone:562-612-8483
Mailing Address - Fax:
Practice Address - Street 1:23945 SUNNYMEAD BLVD STE 3
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3025
Practice Address - Country:US
Practice Address - Phone:562-200-4381
Practice Address - Fax:951-346-4117
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2470A2800XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health InformationAssistant Record Technician