Provider Demographics
NPI:1689449969
Name:TINOCO, KLARISSA MONIQUE
Entity Type:Individual
Prefix:MS
First Name:KLARISSA
Middle Name:MONIQUE
Last Name:TINOCO
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 1:2854 LAKERIDGE CT
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-7864
Mailing Address - Country:US
Mailing Address - Phone:559-909-5949
Mailing Address - Fax:
Practice Address - Street 1:2854 LAKERIDGE CT
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-7864
Practice Address - Country:US
Practice Address - Phone:559-909-5949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer