Healthcare Provider Details

I. General information

NPI: 1225584089
Provider Name (Legal Business Name): LUCIA TEJEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 E FOOTHILL BLVD
PASADENA CA
91107-3406
US

IV. Provider business mailing address

10866 WASHINGTON BLVD # 951
CULVER CITY CA
90232-3610
US

V. Phone/Fax

Practice location:
  • Phone: 310-733-9368
  • Fax:
Mailing address:
  • Phone: 310-733-9368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number71653
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: