Provider Demographics
NPI:1578240305
Name:TEJADA-BREA, YUCLENIA VICTORIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:YUCLENIA
Middle Name:VICTORIA
Last Name:TEJADA-BREA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:YUCLENIA
Other - Middle Name:VICTORIA
Other - Last Name:TEJADA-BREA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1637 PALISADE AVE STE 2N
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6953
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 WINSTON DR APT 3022
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-3233
Practice Address - Country:US
Practice Address - Phone:917-683-5641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY678310163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse