Provider Demographics
NPI:1689851685
Name:TENAZAS, REBECCA P
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:P
Last Name:TENAZAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4949 DILLON CROSS WAY
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-5617
Mailing Address - Country:US
Mailing Address - Phone:916-727-0403
Mailing Address - Fax:
Practice Address - Street 1:4949 DILLON CROSS WAY
Practice Address - Street 2:
Practice Address - City:ANTELOPE
Practice Address - State:CA
Practice Address - Zip Code:95843-5617
Practice Address - Country:US
Practice Address - Phone:916-727-0403
Practice Address - Fax:916-727-1541
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMTN00884F343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN00884FMedicaid