Healthcare Provider Details

I. General information

NPI: 1831365014
Provider Name (Legal Business Name): JAMES R TINIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W BULLARD AVE STE 109
CLOVIS CA
93612-0861
US

IV. Provider business mailing address

2740 HERNDON AVE
CLOVIS CA
93611-6813
US

V. Phone/Fax

Practice location:
  • Phone: 559-299-2608
  • Fax: 559-299-0245
Mailing address:
  • Phone: 559-299-2608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC147075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: