Provider Demographics
NPI:1033507876
Name:AYROSO, ONOFRE GASMEN (DNP, AG-ACNP-BC)
Entity Type:Individual
Prefix:DR
First Name:ONOFRE
Middle Name:GASMEN
Last Name:AYROSO
Suffix:
Gender:M
Credentials:DNP, AG-ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5156 BRENTFORD WAY
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-8032
Mailing Address - Country:US
Mailing Address - Phone:401-662-0484
Mailing Address - Fax:916-993-9611
Practice Address - Street 1:5900 COYLE AVE STE B
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0400
Practice Address - Country:US
Practice Address - Phone:916-515-8855
Practice Address - Fax:916-993-9611
Is Sole Proprietor?:No
Enumeration Date:2015-01-01
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00014363L00000X
MARN2265262363L00000X
CA95004482363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110104477AMedicaid
MA110104477AMedicaid
RIU400214142Medicare PIN