Healthcare Provider Details

I. General information

NPI: 1538699236
Provider Name (Legal Business Name): CHARINETTE DEE GUERRERO GAMBOA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13300 NEW AIRPORT RD
AUBURN CA
95602-7407
US

IV. Provider business mailing address

13300 NEW AIRPORT RD
AUBURN CA
95602-7407
US

V. Phone/Fax

Practice location:
  • Phone: 530-889-8780
  • Fax: 530-889-8781
Mailing address:
  • Phone: 530-889-8780
  • Fax: 530-889-8781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95013188
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number55892
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95013188
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: