Provider Demographics
NPI:1053696278
Name:MAYERS, TELLIES J I
Entity type:Individual
Prefix:
First Name:TELLIES
Middle Name:J
Last Name:MAYERS
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18106 COLTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-1734
Mailing Address - Country:US
Mailing Address - Phone:310-756-6392
Mailing Address - Fax:
Practice Address - Street 1:18106 COLTMAN AVE
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-1734
Practice Address - Country:US
Practice Address - Phone:310-756-6392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator