Provider Demographics
NPI:1265212997
Name:TEJEDA, IRIS CHANTAL (NP)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:CHANTAL
Last Name:TEJEDA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:IRIS
Other - Middle Name:CHANTAL
Other - Last Name:GUERRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4513 BRIANNA CT
Mailing Address - Street 2:
Mailing Address - City:KEYES
Mailing Address - State:CA
Mailing Address - Zip Code:95328-9703
Mailing Address - Country:US
Mailing Address - Phone:209-556-8348
Mailing Address - Fax:
Practice Address - Street 1:2330 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2013
Practice Address - Country:US
Practice Address - Phone:209-250-2530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026885363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health