Provider Demographics
NPI:1285183756
Name:TEJEDA, RAUL
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:TEJEDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14021 SW 22ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7008
Mailing Address - Country:US
Mailing Address - Phone:305-799-9838
Mailing Address - Fax:305-643-3880
Practice Address - Street 1:14021 SW 22ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-7008
Practice Address - Country:US
Practice Address - Phone:305-799-9838
Practice Address - Fax:305-799-9838
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9229162363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily