Provider Demographics
NPI:1376182709
Name:TUTOLO, TAMI
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:
Last Name:TUTOLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 W BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-1492
Mailing Address - Country:US
Mailing Address - Phone:909-741-7124
Mailing Address - Fax:
Practice Address - Street 1:670 W BASELINE RD
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1492
Practice Address - Country:US
Practice Address - Phone:909-741-7124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator