Provider Demographics
NPI:1649579699
Name:TOLENTINO, RICHARD BITANGCOL (MS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:BITANGCOL
Last Name:TOLENTINO
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:
Other - Last Name:TOLENTINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MCLIAUD
Mailing Address - Street 1:3900 CAPITOL MALL DR. SW
Mailing Address - Street 2:CAPITAL MEDICAL CENTER (ENT-AUDIOLOGY CLINIC)
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3900 CAPITOL MALL DR SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8654
Practice Address - Country:US
Practice Address - Phone:562-507-0860
Practice Address - Fax:562-507-0860
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD 60259887231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist