Provider Demographics
NPI:1235737164
Name:CALIMQUIM, TYNESHA FELICE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:TYNESHA
Middle Name:FELICE
Last Name:CALIMQUIM
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:TYNESHA
Other - Middle Name:FELICE
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:42512 GARCIA WAY
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-6645
Mailing Address - Country:US
Mailing Address - Phone:619-977-2168
Mailing Address - Fax:
Practice Address - Street 1:42512 GARCIA WAY
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6645
Practice Address - Country:US
Practice Address - Phone:619-977-2168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2022-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20278124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1167356130OtherMILITARY