Provider Demographics
NPI:1609539063
Name:TENORIO, GUSTAVO RAFAEL (BS KINESIOLOGY)
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:RAFAEL
Last Name:TENORIO
Suffix:
Gender:M
Credentials:BS KINESIOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 TRUXTUN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0656
Mailing Address - Country:US
Mailing Address - Phone:661-632-1540
Mailing Address - Fax:
Practice Address - Street 1:4100 TRUXTUN AVE STE 200
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0656
Practice Address - Country:US
Practice Address - Phone:661-632-1540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist