Healthcare Provider Details

I. General information

NPI: 1164880100
Provider Name (Legal Business Name): MEGHAN CATHLEEN TOLENTINO NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGHAN CATHLEEN GILDAY NP-C

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

947 N HART ST
ORANGE CA
92867-6220
US

IV. Provider business mailing address

947 N HART ST
ORANGE CA
92867-6220
US

V. Phone/Fax

Practice location:
  • Phone: 562-243-8398
  • Fax:
Mailing address:
  • Phone: 562-243-8398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number721285
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95003712
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: