Provider Demographics
NPI:1508919523
Name:TOLENTINO & TOLENTINO M.D. INC.
Entity Type:Organization
Organization Name:TOLENTINO & TOLENTINO M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUTGARDA
Authorized Official - Middle Name:CRUZ
Authorized Official - Last Name:TOLENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-888-7922
Mailing Address - Street 1:6681 RIDGE RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5713
Mailing Address - Country:US
Mailing Address - Phone:440-888-7922
Mailing Address - Fax:440-888-7923
Practice Address - Street 1:6681 RIDGE RD
Practice Address - Street 2:SUITE 304
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5713
Practice Address - Country:US
Practice Address - Phone:440-888-7922
Practice Address - Fax:440-888-7923
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOLENTINO & TOLENTINO M.D.'S INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-21
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35039846-T207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0334918Medicaid
OHA75833Medicare UPIN
OH0334918Medicaid