Provider Demographics
NPI:1093068025
Name:TOLENTINO, TERESITA MUNGUIA (IBCLC)
Entity Type:Individual
Prefix:
First Name:TERESITA
Middle Name:MUNGUIA
Last Name:TOLENTINO
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 TALMADGE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-1952
Mailing Address - Country:US
Mailing Address - Phone:408-821-4462
Mailing Address - Fax:
Practice Address - Street 1:16 TALMADGE AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-1952
Practice Address - Country:US
Practice Address - Phone:408-821-4462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11082772174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN