Healthcare Provider Details

I. General information

NPI: 1104755560
Provider Name (Legal Business Name): TATE CHAMBERS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 48TH ST
SACRAMENTO CA
95817-1541
US

IV. Provider business mailing address

1114 E IRVING AVE
OSHKOSH WI
54901-4618
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2145
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number95261078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: