Provider Demographics
NPI:1326718321
Name:TENORIO CHAVARRIA, YAZMIN AMANDA (PA-C)
Entity Type:Individual
Prefix:
First Name:YAZMIN
Middle Name:AMANDA
Last Name:TENORIO CHAVARRIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 MOKELUMNE DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8057
Mailing Address - Country:US
Mailing Address - Phone:925-478-0117
Mailing Address - Fax:
Practice Address - Street 1:1462 CLIFTON RD NE STE 280
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1063
Practice Address - Country:US
Practice Address - Phone:404-727-9653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant