Provider Demographics
NPI:1801271598
Name:TEJADA, VICENTE REY ADEFUIN (NP)
Entity type:Individual
Prefix:
First Name:VICENTE REY
Middle Name:ADEFUIN
Last Name:TEJADA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 BRISA DEL MAR
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-2611
Mailing Address - Country:US
Mailing Address - Phone:805-757-1987
Mailing Address - Fax:
Practice Address - Street 1:231 BRISA DEL MAR
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-2611
Practice Address - Country:US
Practice Address - Phone:805-757-1987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23034363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care