Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | A160407 | CA |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | MD463754 | PA |
NPI | 1033554423 |
---|---|
Provider Name | Dr. Derrick Tint |
First Address | Irvine, CA 92620-6201 |
Second Address | Murrieta, CA 92563-2007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2013 |
Last Update Date | 20/07/2019 |