Provider Demographics
NPI:1760513972
Name:TEJEDA, JUAN III
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:TEJEDA
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:
Other - Last Name:TEJEDA
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1360 SHADY LN
Mailing Address - Street 2:UNIT #328
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-7401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 E CANAL DR
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-3936
Practice Address - Country:US
Practice Address - Phone:209-669-2583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator