Healthcare Provider Details

I. General information

NPI: 1639935968
Provider Name (Legal Business Name): VINCENT-RAY PADILLA TEJADA JR. NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: VINCE TEJADA

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 JUSTIN WAY
CONCORD CA
94520-1616
US

IV. Provider business mailing address

3025 JUSTIN WAY
CONCORD CA
94520-1616
US

V. Phone/Fax

Practice location:
  • Phone: 805-588-4834
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95029186
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number95248661
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: