Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 0060196 | CO |
N | 207ND0101X | MOHS-Micrographic Surgeon | 0060196 | CO |
NPI | 1457793283 |
---|---|
Provider Name | Tiffany Lee Tello |
First Address | Dallas, TX 75230-5826 |
Second Address | Littleton, CO 80120 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2013 |
Last Update Date | 25/07/2018 |