Provider Demographics
NPI:1932361904
Name:TEJADA-JITSUYA, ROXANA (MD)
Entity type:Individual
Prefix:
First Name:ROXANA
Middle Name:
Last Name:TEJADA-JITSUYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 PINTO LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4018
Mailing Address - Country:US
Mailing Address - Phone:702-542-5868
Mailing Address - Fax:702-991-9807
Practice Address - Street 1:2017 PINTO LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4018
Practice Address - Country:US
Practice Address - Phone:702-542-5868
Practice Address - Fax:702-991-9807
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13608208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1932361904Medicaid
NVDX542YMedicare PIN
NVDX542XMedicare PIN