Provider Demographics
NPI:1679299028
Name:TELOS HEALTH AND PERFORMANCE
Entity type:Organization
Organization Name:TELOS HEALTH AND PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO-GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-706-1194
Mailing Address - Street 1:420 E CHURCH ST UNIT 614
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-2789
Mailing Address - Country:US
Mailing Address - Phone:817-706-1194
Mailing Address - Fax:
Practice Address - Street 1:3154 S ORANGE AVE STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6122
Practice Address - Country:US
Practice Address - Phone:321-300-3113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TELOS HEALTH AND PERFORMANCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty