Provider Demographics
NPI:1013923200
Name:TOLENTINO, MARIFE ROSANNA S (MD)
Entity Type:Individual
Prefix:
First Name:MARIFE
Middle Name:ROSANNA S
Last Name:TOLENTINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIFE
Other - Middle Name:T
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5528 PACHECO BLVD
Mailing Address - Street 2:#A
Mailing Address - City:PACHECO
Mailing Address - State:CA
Mailing Address - Zip Code:94553-5154
Mailing Address - Country:US
Mailing Address - Phone:925-363-8170
Mailing Address - Fax:925-363-4995
Practice Address - Street 1:1001 SNEATH LN
Practice Address - Street 2:STE 104
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-2308
Practice Address - Country:US
Practice Address - Phone:650-873-4545
Practice Address - Fax:650-873-4544
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80451208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A804510Medicaid