Provider Demographics
NPI:1225612096
Name:FONTEJON, JAYDIENNE PAULISA CRUZ (DPM)
Entity type:Individual
Prefix:DR
First Name:JAYDIENNE PAULISA
Middle Name:CRUZ
Last Name:FONTEJON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 E 22ND ST STE 205
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6108
Mailing Address - Country:US
Mailing Address - Phone:630-953-8088
Mailing Address - Fax:630-953-8094
Practice Address - Street 1:10 E 22ND ST STE 205
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6108
Practice Address - Country:US
Practice Address - Phone:630-953-8088
Practice Address - Fax:630-953-8094
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016006055213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist