Provider Demographics
NPI:1033459920
Name:MATURINO, TINA SHAIA (CLMT)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:SHAIA
Last Name:MATURINO
Suffix:
Gender:F
Credentials:CLMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1156 N PUENTE ST
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-2223
Mailing Address - Country:US
Mailing Address - Phone:714-742-6067
Mailing Address - Fax:
Practice Address - Street 1:1156 N PUENTE ST
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-2223
Practice Address - Country:US
Practice Address - Phone:714-742-6067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist