Provider Demographics
NPI:1710033592
Name:TENAZAS, DARYL J
Entity Type:Individual
Prefix:MR
First Name:DARYL
Middle Name:J
Last Name:TENAZAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 28TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-2913
Mailing Address - Country:US
Mailing Address - Phone:916-727-2547
Mailing Address - Fax:916-745-4195
Practice Address - Street 1:6901 28TH ST
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-2913
Practice Address - Country:US
Practice Address - Phone:916-727-2547
Practice Address - Fax:916-745-4195
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8799037OtherNEMT