Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 95011350 | CA |
NPI | 1033751938 |
---|---|
Provider Name | Mr. Raymond Balagtas Tinio |
First Address | Colton, CA 92324-2747 |
Second Address | Colton, CA 92324-2747 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2019 |
Last Update Date | 11/10/2019 |