Provider Demographics
NPI:1700277001
Name:GORAB, TENZIN
Entity Type:Individual
Prefix:MS
First Name:TENZIN
Middle Name:
Last Name:GORAB
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TENZIN
Other - Middle Name:
Other - Last Name:GORAB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:1747 N MARKET BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-2979
Mailing Address - Country:US
Mailing Address - Phone:360-901-2545
Mailing Address - Fax:
Practice Address - Street 1:1747 N MARKET BLVD STE 150
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-2979
Practice Address - Country:US
Practice Address - Phone:360-901-2545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000000163W00000X
OR201507095NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse