Healthcare Provider Details

I. General information

NPI: 1447404926
Provider Name (Legal Business Name): EDGARDO TOLENTINO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2008
Last Update Date: 10/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5674 STONERIDGE DR SUITE 108
PLEASANTON CA
94588-8500
US

IV. Provider business mailing address

5674 STONERIDGE DR
PLEASANTON CA
94588-8500
US

V. Phone/Fax

Practice location:
  • Phone: 925-520-0066
  • Fax:
Mailing address:
  • Phone: 925-520-0005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA37186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: