Healthcare Provider Details

I. General information

NPI: 1649910910
Provider Name (Legal Business Name): TINA HRINKO-OTERO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TINA OTERO

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 S MCDOWELL BLVD
PETALUMA CA
94954-3507
US

IV. Provider business mailing address

8945 GOLF LINKS RD
OAKLAND CA
94605-4124
US

V. Phone/Fax

Practice location:
  • Phone: 707-293-1110
  • Fax:
Mailing address:
  • Phone: 510-317-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95029177
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95271977
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: