Healthcare Provider Details

I. General information

NPI: 1780615930
Provider Name (Legal Business Name): GEMORSITA M. TENAZAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 E TEMPLE ST
LOS ANGELES CA
90012-3328
US

IV. Provider business mailing address

19054 MERION DR
NORTHRIDGE CA
91326-1833
US

V. Phone/Fax

Practice location:
  • Phone: 213-253-2677
  • Fax:
Mailing address:
  • Phone: 213-253-2677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA-32649
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: