MEDICARE: MS. MARIANE TOLENTINO IDMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1710I1003X	Independent Duty Medical Technicians

General Provider Information

NPI Number	:	1861835944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIANE TOLENTINO IDMT

Provider Business Mailing Address
First Line	:	2655 E DEER SPRINGS WAY
Second Line	:	APT 3118
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1407
Country	:	US
Telephone Number	:	702-653-2344
Fax Number	:

Provider Business Practice Location Address
First Line	:	2655 E DEER SPRINGS WAY
Second Line	:	APT 3118
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1407
Country	:	US
Telephone Number	:	702-653-2344
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2013
Last Update Date	:	06/05/2013

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