Provider Demographics
NPI:1164260816
Name:UMPIERRE TENDERO, OSCAR
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:
Last Name:UMPIERRE TENDERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 CRESTWOOD FOREST DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-3073
Mailing Address - Country:US
Mailing Address - Phone:817-749-7177
Mailing Address - Fax:
Practice Address - Street 1:3222 CRESTWOOD FOREST DR
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-3073
Practice Address - Country:US
Practice Address - Phone:817-749-7177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR24564208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program