Provider Demographics
NPI:1619139300
Name:TOLENTINO, ANNA LOURDES (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:LOURDES
Last Name:TOLENTINO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:ANNA LOURDES
Other - Middle Name:SERNICULA
Other - Last Name:DELA CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2446 ROWNTREE WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-4043
Mailing Address - Country:US
Mailing Address - Phone:415-342-7242
Mailing Address - Fax:
Practice Address - Street 1:1550 SILVEIRA PKWY
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-4879
Practice Address - Country:US
Practice Address - Phone:415-446-3817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist