Provider Demographics
NPI:1013018639
Name:TINOCO, TOLENTINO (PA)
Entity Type:Individual
Prefix:
First Name:TOLENTINO
Middle Name:
Last Name:TINOCO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11957 REDBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-6082
Mailing Address - Country:US
Mailing Address - Phone:407-856-4947
Mailing Address - Fax:
Practice Address - Street 1:931 W OAK ST
Practice Address - Street 2:STE 103
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4973
Practice Address - Country:US
Practice Address - Phone:407-931-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100861207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine