Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 28979 | CA |
NPI | 1003204603 |
---|---|
Provider Name | Ms. Mary Claire Tolentino |
First Address | San Jose, CA 95136-2203 |
Second Address | San Jose, CA 95136-2203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2015 |
Last Update Date | 05/01/2015 |