Active NPI
Christine C Telleen, M.A.
- Audiologist
- San Mateo, CA
National Provider Identifier
1679620264
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- AU372
- Practice address
- 100 S Ellsworth Ave
303
San Mateo, CA 94401-3939 - Phone
- (650) 579-4470
- NPI assigned
- Jan 4, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | AU372 | CA | Primary |
Addresses
Primary practice location
100 S Ellsworth Ave
303
San Mateo, CA 94401-3939
Mailing address
701 Laurelwood Dr
San Mateo, CA 94403-4029
Phone (650) 341-9437
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| BU187Y | Other | CA | MEDICARE PTAN FOR PENINSULA MEDICAL CLINIC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 372 | CA | MD | Professional Counselor |
| AU372 | CA | MD | Audiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1512172800000",
"number": "1679620264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "701 LAURELWOOD DR",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944034029",
"telephone_number": "650-341-9437"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 S ELLSWORTH AVE",
"address_2": "303",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944013939",
"telephone_number": "650-579-4470"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TELLEEN",
"first_name": "CHRISTINE",
"middle_name": "C",
"name_prefix": "Ms.",
"credential": "M.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-04",
"last_updated": "2017-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "CA",
"license": "AU372",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN FOR PENINSULA MEDICAL CLINIC",
"identifier": "BU187Y",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Mateo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.