Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 11843 | NV |
NPI | 1194725358 |
---|---|
Provider Name | Dr. Jeanette Galicinao Tolentino |
First Address | Henderson, NV 89044-0458 |
Second Address | Las Vegas, NV 89102-2329 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 23/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I00707 | (02) | TN |