Provider Demographics
NPI:1326670050
Name:TEJEDA, ITZEL AMACALLI
Entity Type:Individual
Prefix:
First Name:ITZEL
Middle Name:AMACALLI
Last Name:TEJEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7309 DESIERTO MAIZ CT
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7687
Mailing Address - Country:US
Mailing Address - Phone:915-383-2464
Mailing Address - Fax:
Practice Address - Street 1:7309 DESIERTO MAIZ CT
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-7687
Practice Address - Country:US
Practice Address - Phone:915-383-2464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst