Provider Demographics
NPI:1639276371
Name:TENDERO, JOSE ANGEL (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ANGEL
Last Name:TENDERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8013 NW 163RD TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6104
Mailing Address - Country:US
Mailing Address - Phone:305-826-4659
Mailing Address - Fax:
Practice Address - Street 1:681 E 9TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4523
Practice Address - Country:US
Practice Address - Phone:305-805-8550
Practice Address - Fax:305-805-8549
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0066408207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine