Provider Demographics
NPI:1174772396
Name:TRELLES, IDELSIS (PA-C)
Entity type:Individual
Prefix:MRS
First Name:IDELSIS
Middle Name:
Last Name:TRELLES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7721 NW 7TH ST APT 817
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-6110
Mailing Address - Country:US
Mailing Address - Phone:305-281-4622
Mailing Address - Fax:
Practice Address - Street 1:7300 SW 62ND PL
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4806
Practice Address - Country:US
Practice Address - Phone:305-665-1133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104276363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant