Healthcare Provider Details

I. General information

NPI: 1225833155
Provider Name (Legal Business Name): DENITZA DARIELA TEJADA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2025
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 MARGINAL GONZALEZ EDIFICIO BIANCA PRIMER PISO, SUITE 102
ANASCO PR
00610
US

IV. Provider business mailing address

HC 2 BOX 13126
MOCA PR
00676-8241
US

V. Phone/Fax

Practice location:
  • Phone: 787-423-2481
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1398
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: