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NPI Code Detail

MEDICARE: TANYA KAILATH GNP-BC

MEDICARE: TANYA KAILATH GNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP2300XPrimary Care Nurse Practitioner277871MA
2363LG0600XGerontology Nurse Practitioner19491CA

General Provider Information

NPI Number : 1932437076
Entity Type Code : Individual
Provider Name (Legal Business Name) : TANYA KAILATH GNP-BC
Provider Business Mailing Address
First Line : 10690 SAN PABLO AVE # CA
Second Line :
City : EL CERRITO
State : CA
Zip : 94530-2620
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10690 SAN PABLO AVE
Second Line :
City : EL CERRITO
State : CA
Zip : 94530-2620
Country : US
Telephone Number : 916-813-5212
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2009
Last Update Date : 12/05/2024

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Directions to “ TANYA KAILATH GNP-BC” Practice Location

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