Provider Demographics
NPI:1326142910
Name:TINKLE, LILY LIOU (MD)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:LIOU
Last Name:TINKLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7544 MORRO RD
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-4404
Mailing Address - Country:US
Mailing Address - Phone:805-464-2755
Mailing Address - Fax:805-464-2756
Practice Address - Street 1:7544 MORRO RD
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-4404
Practice Address - Country:US
Practice Address - Phone:805-464-2755
Practice Address - Fax:805-464-2756
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68614207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology