Healthcare Provider Details

I. General information

NPI: 1992558589
Provider Name (Legal Business Name): ERIC J TENORIO CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3633 E BROADWAY
LONG BEACH CA
90803-6035
US

IV. Provider business mailing address

3633 E BROADWAY
LONG BEACH CA
90803-6035
US

V. Phone/Fax

Practice location:
  • Phone: 562-772-9688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License NumberRA2070426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: