Provider Demographics
NPI:1326698218
Name:TOLENTINO, REBECCA FRUELDA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:FRUELDA
Last Name:TOLENTINO
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:TOLENTINO
Other - Last Name:ZEPEDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:3843 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-5229
Mailing Address - Country:US
Mailing Address - Phone:661-674-0336
Mailing Address - Fax:
Practice Address - Street 1:3843 GRANDVIEW DR
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-5229
Practice Address - Country:US
Practice Address - Phone:661-674-0336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA775312163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse