Provider Demographics
NPI:1851593719
Name:TEJADA GARCIA, CARMEN YDERCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:YDERCIS
Last Name:TEJADA GARCIA
Suffix:
Gender:F
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:RB7 PLAZA 1
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6085
Mailing Address - Country:US
Mailing Address - Phone:787-366-5281
Mailing Address - Fax:
Practice Address - Street 1:RB7 PLAZA 1
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-6085
Practice Address - Country:US
Practice Address - Phone:787-283-1292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8280208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice