Healthcare Provider Details

I. General information

NPI: 1699808378
Provider Name (Legal Business Name): TENNILLE RENEE ROBERTS CAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TENNILLE RENEE DE LA TORRE

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 COURAGE DR
FAIRFIELD CA
94533-6717
US

IV. Provider business mailing address

7000 LEISURE TOWN RD
VACAVILLE CA
95688-9413
US

V. Phone/Fax

Practice location:
  • Phone: 707-784-2057
  • Fax: 707-427-2981
Mailing address:
  • Phone: 707-249-1062
  • Fax: 707-453-0384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number03-061421
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: