Healthcare Provider Details

I. General information

NPI: 1619895380
Provider Name (Legal Business Name): RUBEN TINAJERO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 E ALVIN DR STE E
SALINAS CA
93906-3056
US

IV. Provider business mailing address

631 E ALVIN DR STE E
SALINAS CA
93906-3056
US

V. Phone/Fax

Practice location:
  • Phone: 831-443-5801
  • Fax:
Mailing address:
  • Phone: 831-443-5801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113412
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: