Healthcare Provider Details

I. General information

NPI: 1073557880
Provider Name (Legal Business Name): GERARDO TEJEDOR GONZALEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#55 CALLE DEL CARMEN
FAJARDO PR
00738
US

IV. Provider business mailing address

PMB - 258 PO BOX 70005
FAJARDO PR
00738
US

V. Phone/Fax

Practice location:
  • Phone: 787-860-3558
  • Fax: 787-860-3330
Mailing address:
  • Phone: 787-860-3558
  • Fax: 787-860-3330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number7718
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: