Provider Demographics
NPI:1861835944
Name:TOLENTINO, MARIANE (IDMT)
Entity Type:Individual
Prefix:MS
First Name:MARIANE
Middle Name:
Last Name:TOLENTINO
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 E DEER SPRINGS WAY
Mailing Address - Street 2:APT 3118
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89086-1407
Mailing Address - Country:US
Mailing Address - Phone:702-653-2344
Mailing Address - Fax:
Practice Address - Street 1:2655 E DEER SPRINGS WAY
Practice Address - Street 2:APT 3118
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-1407
Practice Address - Country:US
Practice Address - Phone:702-653-2344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians