Active NPI
Pavel Miguel Lopez Telleria, APRN
- Family Nurse Practitioner
- Hialeah, FL
National Provider Identifier
1952907669
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 11010476
- Practice address
- 9317 NW 114TH LN
Hialeah, FL 33018-4269 - Phone
- (786) 333-6845
- NPI assigned
- Dec 8, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 11010476 | FL | Primary |
Addresses
Primary practice location
9317 NW 114TH LN
Hialeah, FL 33018-4269
Mailing address
9317 NW 114TH LN
Hialeah, FL 33018-4269
Phone (786) 333-6845
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11010476 | FL | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607385600000",
"number": "1952907669",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9317 NW 114TH LN",
"city": "HIALEAH",
"state": "FL",
"postal_code": "330184269",
"telephone_number": "786-333-6845"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9317 NW 114TH LN",
"city": "HIALEAH",
"state": "FL",
"postal_code": "330184269",
"telephone_number": "786-333-6845"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOPEZ TELLERIA",
"first_name": "PAVEL",
"middle_name": "MIGUEL",
"credential": "APRN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-12-08",
"last_updated": "2020-12-08",
"certification_date": "2020-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": "FL",
"license": "11010476",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hialeah, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.