Luis Carlos Teller

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

1100 Wilford Hall Loop
Jbsa Lackland, TX 78236-5638

Phone

(210) 292-3337

Fax

(210) 292-2052

NPI assigned

Feb 29, 2024

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Optimum Health LLC

  • Family Medicine Physician
  • Alexandria, VA
  • NPI 1417723545
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1709164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775433600000",
    "number": "1417714106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 WILFORD HALL LOOP",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782365638",
            "telephone_number": "210-292-3337",
            "fax_number": "210-292-2052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 WILFORD HALL LOOP",
            "city": "JBSA LACKLAND",
            "state": "TX",
            "postal_code": "782365638",
            "telephone_number": "210-292-3337",
            "fax_number": "210-292-2052"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6354 Walker Ln Ste 350",
            "address_purpose": "LOCATION",
            "city": "Alexandria",
            "state": "VA",
            "postal_code": "223103256",
            "country_code": "US",
            "telephone_number": "256-425-4050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TELLER",
        "first_name": "LUIS",
        "middle_name": "CARLOS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-02-29",
        "last_updated": "2026-04-06",
        "certification_date": "2026-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gerald Wayne Talcott, PHD
• Brenda Karina Tanyi, PHYSICIAN ASSISTANT
• April Jo Taylor, AU.D.
• Jared Ross Taylor, PA-C
• Sean William Taylor, DMD
• Theresa Ten Haaf, DMD
• Mitzi Deeneen Thomas-Lawson, MSSW
• Shannon Nicole Thompson
• Juby Oommen Thuruthumaly, PHARMACIST
• Hai M Tien, MD

• Physician Assistant in Jbsa Lackland, TX
• Providers in Jbsa Lackland, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.