Provider Demographics
NPI:1952096364
Name:TOLENTINO, JESSICA LEIGH (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LEIGH
Last Name:TOLENTINO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11713 AVON WAY APT 16
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-7216
Mailing Address - Country:US
Mailing Address - Phone:619-723-2986
Mailing Address - Fax:
Practice Address - Street 1:11620 WILSHIRE BLVD STE 710
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1781
Practice Address - Country:US
Practice Address - Phone:310-444-9393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36589111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor