MEDICARE: WILKIANA TEJERA PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	853	PR

General Provider Information

NPI Number	:	1407422215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILKIANA TEJERA PA

Provider Business Mailing Address
First Line	:	289 CALLE DELBREY
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00912-3437
Country	:	US
Telephone Number	:	787-922-9203
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 CALLE RODRIGO DE TRIANA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3206
Country	:	US
Telephone Number	:	787-756-6515
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2021
Last Update Date	:	06/02/2021

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