Provider Demographics
NPI:1093798092
Name:TOLENTINO, ETHELYNDA A (MD)
Entity Type:Individual
Prefix:DR
First Name:ETHELYNDA
Middle Name:A
Last Name:TOLENTINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ETHELYNDA
Other - Middle Name:A
Other - Last Name:JAOJOCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1528 EUREKA RD STE 103
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3047
Mailing Address - Country:US
Mailing Address - Phone:916-772-5325
Mailing Address - Fax:916-772-6333
Practice Address - Street 1:4420 DUCKHORN DR STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-2590
Practice Address - Country:US
Practice Address - Phone:916-419-9990
Practice Address - Fax:916-419-9699
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA837492081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH86770Medicare UPIN