Provider Demographics
NPI:1457532889
Name:TEJADA, PAULINO SEGUNDO
Entity Type:Individual
Prefix:
First Name:PAULINO
Middle Name:SEGUNDO
Last Name:TEJADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PAULINO
Other - Middle Name:S
Other - Last Name:TEJADA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:118 SAINT JOHN ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-3431
Mailing Address - Country:US
Mailing Address - Phone:610-481-0444
Mailing Address - Fax:
Practice Address - Street 1:118 SAINT JOHN ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-3431
Practice Address - Country:US
Practice Address - Phone:610-481-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN746224163WD0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator