Healthcare Provider Details

I. General information

NPI: 1740761535
Provider Name (Legal Business Name): SARAH TOMINELLO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date: 07/07/2019
Reactivation Date: 09/25/2019

III. Provider practice location address

440 N BARRANCA AVE STE 6078
COVINA CA
91723-1722
US

IV. Provider business mailing address

440 N BARRANCA AVE STE 6078
COVINA CA
91723-1722
US

V. Phone/Fax

Practice location:
  • Phone: 213-805-7994
  • Fax: 559-235-7028
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95143080
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95012100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: