Provider Demographics
NPI:1407289044
Name:TEJEDA, PATRICIA (MS)
Entity Type:Individual
Prefix:MISS
First Name:PATRICIA
Middle Name:
Last Name:TEJEDA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 BAKER ST
Mailing Address - Street 2:APT. G204
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4413
Mailing Address - Country:US
Mailing Address - Phone:714-474-9347
Mailing Address - Fax:714-957-1065
Practice Address - Street 1:18302 IRVINE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3435
Practice Address - Country:US
Practice Address - Phone:714-881-8617
Practice Address - Fax:714-957-1065
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health