Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | A110417 | CA |
Y | 111NI0900X | Internist | A110417 | CA |
N | 207RI0200X | Infectious Disease | A110417 | CA |
NPI | 1003073826 |
---|---|
Provider Name | David Michael Tellalian |
First Address | Champions Gate, FL 33896-8310 |
Second Address | Los Angeles, CA 90048-6111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2008 |
Last Update Date | 19/02/2020 |