Provider Demographics
NPI:1396815593
Name:TOLENTINO, ALTAGRACIA B (MD)
Entity Type:Individual
Prefix:
First Name:ALTAGRACIA
Middle Name:B
Last Name:TOLENTINO
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 1:2411 GUNTHER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-6245
Mailing Address - Country:US
Mailing Address - Phone:718-991-0605
Mailing Address - Fax:718-991-2931
Practice Address - Street 1:890 PROSPECT AVENUE
Practice Address - Street 2:CENTER FOR CHILDREN HEALTH AND RESILIENCY
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459
Practice Address - Country:US
Practice Address - Phone:718-991-0605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201735208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics