Provider Demographics
NPI:1629887716
Name:BOERNER, TATYANA
Entity type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:BOERNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:
Other - Last Name:BOERNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:235 E ST
Mailing Address - Street 2:
Mailing Address - City:RIO LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:95673-4131
Mailing Address - Country:US
Mailing Address - Phone:916-224-1214
Mailing Address - Fax:
Practice Address - Street 1:3960 INDUSTRIAL BLVD # 600
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3496
Practice Address - Country:US
Practice Address - Phone:916-752-8965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program