Healthcare Provider Details

I. General information

NPI: 1669548780
Provider Name (Legal Business Name): SHARON MAE GABERTAN TENAZAS NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 ATLANTIC AVE SUITE 715
LONG BEACH CA
90813-3408
US

IV. Provider business mailing address

1045 ATLANTIC AVE SUITE 715
LONG BEACH CA
90813-3408
US

V. Phone/Fax

Practice location:
  • Phone: 562-983-5408
  • Fax: 562-432-1864
Mailing address:
  • Phone: 562-983-5408
  • Fax: 562-432-1864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN436900
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number436900
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: