Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | A83749 | CA |
NPI | 1093798092 |
---|---|
Provider Name | Dr. Ethelynda A Tolentino |
First Address | Roseville, CA 95661-3047 |
Second Address | Sacramento, CA 95834-2590 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 27/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H86770 | (02) | CA |