Provider Demographics
NPI:1649588773
Name:TEJADA, CANDIDO F (HS)
Entity Type:Individual
Prefix:
First Name:CANDIDO
Middle Name:F
Last Name:TEJADA
Suffix:
Gender:M
Credentials:HS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11031 NE 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-7182
Mailing Address - Country:US
Mailing Address - Phone:305-398-6100
Mailing Address - Fax:305-757-4465
Practice Address - Street 1:120 NW 59TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-1218
Practice Address - Country:US
Practice Address - Phone:305-758-3634
Practice Address - Fax:305-759-5869
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker