Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | BOC159711 | CA |
Y | 213ES0000X | Sports Medicine | BOC159711 | CA |
N | 226300000X | Kinesiotherapist |
NPI | 1780274167 |
---|---|
Provider Name | Tahmineh Marie Tolentino |
First Address | Santa Cruz, CA 95064-1077 |
Second Address | Santa Cruz, CA 95064-1077 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2021 |
Last Update Date | 20/01/2021 |