Healthcare Provider Details

I. General information

NPI: 1639276371
Provider Name (Legal Business Name): JOSE ANGEL TENDERO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 09/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 E 9TH ST
HIALEAH FL
33010-4523
US

IV. Provider business mailing address

8013 NW 163RD TER
MIAMI LAKES FL
33016-6104
US

V. Phone/Fax

Practice location:
  • Phone: 305-805-8550
  • Fax: 305-805-8549
Mailing address:
  • Phone: 305-826-4659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME 0066408
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: