Provider Demographics
NPI:1497257505
Name:TOLENTINO, ARDIENTES C (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:ARDIENTES
Middle Name:C
Last Name:TOLENTINO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8390 E WOODSON ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-3349
Mailing Address - Country:US
Mailing Address - Phone:714-883-0094
Mailing Address - Fax:
Practice Address - Street 1:3030 W BALL RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3805
Practice Address - Country:US
Practice Address - Phone:714-423-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23054207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265470868Medicaid