Provider Demographics
NPI:1710905914
Name:TEJEDA, ANGEL E (MD)
Entity Type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:E
Last Name:TEJEDA
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 1:4305 E 8TH AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-2465
Mailing Address - Country:US
Mailing Address - Phone:305-693-6305
Mailing Address - Fax:305-456-0082
Practice Address - Street 1:4305 E 8TH AVE
Practice Address - Street 2:SUITE C
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-2465
Practice Address - Country:US
Practice Address - Phone:305-693-6305
Practice Address - Fax:305-456-0082
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065366207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376300501Medicaid
FL376300501Medicaid
FL26181AMedicare PIN