Provider Demographics
NPI:1720230543
Name:DECK, TATYANA (PA)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:DECK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1860 HOWE AVE STE 440
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-1098
Mailing Address - Country:US
Mailing Address - Phone:916-569-8484
Mailing Address - Fax:
Practice Address - Street 1:155 15TH ST STE A
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3737
Practice Address - Country:US
Practice Address - Phone:916-454-2345
Practice Address - Fax:916-457-2667
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2023-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA19865363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical