Basic Information
| Provider Information | |||||||||
| NPI: | 1316546856 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TEJADA | ||||||||
| FirstName: | STEPHANIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1748 MINTWOOD DR | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945212152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152050992 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2540 EAST ST | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945201906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256828200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2020 | ||||||||
| LastUpdateDate: | 03/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 95027035 | CA | N | Nursing Service Providers | Registered Nurse | 367500000X | 253586 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.