Provider Demographics
NPI:1710079603
Name:TOLENTINO, LUCILENE F (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCILENE
Middle Name:F
Last Name:TOLENTINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12021 S. WILMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059
Mailing Address - Country:US
Mailing Address - Phone:310-668-4476
Mailing Address - Fax:310-885-4637
Practice Address - Street 1:12021 S. WILMINGTON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059
Practice Address - Country:US
Practice Address - Phone:562-427-5363
Practice Address - Fax:562-427-8802
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76749207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAM050376Medicare PIN
CAAQ805ZMedicare PIN