Healthcare Provider Details

I. General information

NPI: 1023738408
Provider Name (Legal Business Name): PAGE TENLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 03/10/2024
Certification Date: 03/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 H ST
SAN RAFAEL CA
94901-1700
US

IV. Provider business mailing address

424 SUNNYSLOPE AVE
OAKLAND CA
94610-1424
US

V. Phone/Fax

Practice location:
  • Phone: 415-459-4907
  • Fax:
Mailing address:
  • Phone: 510-912-0893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA63962
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: