Provider Demographics
NPI:1760159123
Name:TEJEDA, ANA MARTHA (AUD)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:MARTHA
Last Name:TEJEDA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W MAYES ST
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-3414
Mailing Address - Country:US
Mailing Address - Phone:707-514-6717
Mailing Address - Fax:
Practice Address - Street 1:1600 LOS GAMOS DR STE 120
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1807
Practice Address - Country:US
Practice Address - Phone:415-209-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist