Provider Demographics
NPI:1558472845
Name:TINIO, SUSANNA (PA)
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:
Last Name:TINIO
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 1:365 HAWTHORNE AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3107
Mailing Address - Country:US
Mailing Address - Phone:510-832-6131
Mailing Address - Fax:
Practice Address - Street 1:365 HAWTHORNE AVE
Practice Address - Street 2:STE 103
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3107
Practice Address - Country:US
Practice Address - Phone:510-832-6131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18250363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PA18250Medicare ID - Type UnspecifiedPHYSICIAN ASSISTANT