Healthcare Provider Details

I. General information

NPI: 1598669079
Provider Name (Legal Business Name): DENMARK GATCHALON RABAGO FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4112 E COMMERCE WAY
SACRAMENTO CA
95834-9680
US

IV. Provider business mailing address

5684 BAY ST APT 537
EMERYVILLE CA
94608-2415
US

V. Phone/Fax

Practice location:
  • Phone: 916-389-2725
  • Fax:
Mailing address:
  • Phone: 808-729-0112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95041351
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: