MEDICARE: JOAN TADEJA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	560044	CA

General Provider Information

NPI Number	:	1568984524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN TADEJA

Provider Business Mailing Address
First Line	:	748 BOUNTY DR APT 4810
Second Line	:
City	:	FOSTER CITY
State	:	CA
Zip	:	94404-2675
Country	:	US
Telephone Number	:	650-762-9608
Fax Number	:

Provider Business Practice Location Address
First Line	:	748 BOUNTY DR APT 4810
Second Line	:
City	:	FOSTER CITY
State	:	CA
Zip	:	94404-2675
Country	:	US
Telephone Number	:	650-762-9608
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2017
Last Update Date	:	07/21/2022

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