Healthcare Provider Details

I. General information

NPI: 1700114485
Provider Name (Legal Business Name): BOLORMAA TSERENDEJID
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2009
Last Update Date: 11/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 GAZANIA CT
SACRAMENTO CA
95835-1774
US

IV. Provider business mailing address

35 GAZANIA CT
SACRAMENTO CA
95835-1774
US

V. Phone/Fax

Practice location:
  • Phone: 916-642-6096
  • Fax: 916-285-6286
Mailing address:
  • Phone: 916-642-6096
  • Fax: 916-285-6286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: