Provider Demographics
NPI:1356823207
Name:GIORDANO, TINA
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:GIORDANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26830 HOSTETTLER RD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-5210
Mailing Address - Country:US
Mailing Address - Phone:951-250-9970
Mailing Address - Fax:
Practice Address - Street 1:31764 CASINO DR
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4571
Practice Address - Country:US
Practice Address - Phone:951-471-4645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA687897164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA164X00000XOtherLICENSED VOVATIONAL NURSE
CA164XOOOOOXOtherCOUNTY OF RIVERSIDE