Provider Demographics
NPI:1366574725
Name:TEJEDA, CARLOS MANUEL (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:MANUEL
Last Name:TEJEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3374
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-3374
Mailing Address - Country:US
Mailing Address - Phone:787-655-4060
Mailing Address - Fax:787-801-0505
Practice Address - Street 1:AVE. GENERAL VALERO 410
Practice Address - Street 2:TORRE SAN PABLO DEL ESTE SUITE 205
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-655-4060
Practice Address - Fax:787-801-0505
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13092207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0020346Medicare ID - Type Unspecified