Provider Demographics
NPI:1952485534
Name:TINOCO, MONA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MONA
Middle Name:
Last Name:TINOCO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5823 YORK BLVD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-2634
Mailing Address - Country:US
Mailing Address - Phone:323-255-5643
Mailing Address - Fax:323-254-2158
Practice Address - Street 1:815 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-6123
Practice Address - Country:US
Practice Address - Phone:323-728-3955
Practice Address - Fax:323-254-2158
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14495363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant