Provider Demographics
NPI:1417163312
Name:TOLENTINO, ANGELICA L (DO)
Entity Type:Individual
Prefix:DR
First Name:ANGELICA
Middle Name:L
Last Name:TOLENTINO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17495 LA GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-7581
Mailing Address - Country:US
Mailing Address - Phone:708-226-7000
Mailing Address - Fax:708-226-7170
Practice Address - Street 1:17495 LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-7581
Practice Address - Country:US
Practice Address - Phone:708-226-7000
Practice Address - Fax:708-226-7170
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36118324207R00000X
IL036118324207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine