Provider Demographics
NPI:1477331007
Name:TEJADA, MANUEL ENRIQUE (MBA)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:ENRIQUE
Last Name:TEJADA
Suffix:
Gender:M
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 BAY AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-7956
Mailing Address - Country:US
Mailing Address - Phone:479-713-0080
Mailing Address - Fax:
Practice Address - Street 1:1380 BAY AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-7956
Practice Address - Country:US
Practice Address - Phone:479-713-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator