Provider Demographics
NPI:1508006297
Name:TINNIN, RICCA (PA)
Entity Type:Individual
Prefix:MS
First Name:RICCA
Middle Name:
Last Name:TINNIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N STATE ST.
Mailing Address - Street 2:DEPT E.R.
Mailing Address - City:LA
Mailing Address - State:CA
Mailing Address - Zip Code:90023
Mailing Address - Country:US
Mailing Address - Phone:323-409-6715
Mailing Address - Fax:
Practice Address - Street 1:1200 N STATE ST.
Practice Address - Street 2:DEPT E.R.
Practice Address - City:LA
Practice Address - State:CA
Practice Address - Zip Code:90023
Practice Address - Country:US
Practice Address - Phone:323-409-6715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12115363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant