Provider Demographics
NPI:1518510049
Name:TEJEDA, JOSE
Entity Type:Individual
Prefix:
First Name:JOSE
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 1:7216 N 34TH ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-0570
Mailing Address - Country:US
Mailing Address - Phone:956-522-4099
Mailing Address - Fax:
Practice Address - Street 1:2428 S 23RD ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-5664
Practice Address - Country:US
Practice Address - Phone:956-522-4099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver