Provider Demographics
NPI:1255170999
Name:MEDINA TOVAR, CINTHYA CLARISSA (DDS)
Entity type:Individual
Prefix:
First Name:CINTHYA
Middle Name:CLARISSA
Last Name:MEDINA TOVAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 ABERDEEN ST UNIT 5
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-7565
Mailing Address - Country:US
Mailing Address - Phone:559-556-9747
Mailing Address - Fax:
Practice Address - Street 1:869 W LACEY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-4319
Practice Address - Country:US
Practice Address - Phone:559-530-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1100241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice