Provider Demographics
NPI:1851068308
Name:TOLINO, LARRY JR
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:TOLINO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:
Mailing Address - City:FORT APACHE
Mailing Address - State:AZ
Mailing Address - Zip Code:85926
Mailing Address - Country:US
Mailing Address - Phone:928-338-1021
Mailing Address - Fax:928-338-1022
Practice Address - Street 1:105 GENERAL CROOK ST.
Practice Address - Street 2:
Practice Address - City:FORT APACHE
Practice Address - State:AZ
Practice Address - Zip Code:85926
Practice Address - Country:US
Practice Address - Phone:928-338-1021
Practice Address - Fax:928-338-1022
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health