Provider Demographics
NPI:1750558433
Name:LANTIGUA TEJADA, SUSANA ELVIRA (MD)
Entity type:Individual
Prefix:
First Name:SUSANA
Middle Name:ELVIRA
Last Name:LANTIGUA TEJADA
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:PO BOX 9088
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-9088
Mailing Address - Country:US
Mailing Address - Phone:787-736-6543
Mailing Address - Fax:787-736-6543
Practice Address - Street 1:LUIS MUNOZ RIVERA
Practice Address - Street 2:157
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754
Practice Address - Country:US
Practice Address - Phone:787-736-6543
Practice Address - Fax:787-736-6543
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17130208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice