Provider Demographics
NPI:1578223061
Name:TOLENTINO, PRECIOUS MAE POBLETE
Entity Type:Individual
Prefix:
First Name:PRECIOUS MAE
Middle Name:POBLETE
Last Name:TOLENTINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2337 SPRINGDALE CT APT I5
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-1625
Mailing Address - Country:US
Mailing Address - Phone:229-347-6644
Mailing Address - Fax:
Practice Address - Street 1:2337 SPRINGDALE CT APT I5
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-1625
Practice Address - Country:US
Practice Address - Phone:229-347-6644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012140261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy