Healthcare Provider Details

I. General information

NPI: 1033507876
Provider Name (Legal Business Name): ONOFRE GASMEN AYROSO DNP, AG-ACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2015
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 COYLE AVE STE B
CARMICHAEL CA
95608-0400
US

IV. Provider business mailing address

5156 BRENTFORD WAY
EL DORADO HILLS CA
95762-8032
US

V. Phone/Fax

Practice location:
  • Phone: 916-515-8855
  • Fax: 916-993-9611
Mailing address:
  • Phone: 401-662-0484
  • Fax: 916-993-9611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN00014
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2265262
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95004482
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: