Healthcare Provider Details

I. General information

NPI: 1346435625
Provider Name (Legal Business Name): BIBIANE KIM TINIO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 03/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 WASHINGTON ST SUITE 601
SAN DIEGO CA
92103-2213
US

IV. Provider business mailing address

550 WASHINGTON ST SUITE 601
SAN DIEGO CA
92103-2213
US

V. Phone/Fax

Practice location:
  • Phone: 619-260-7021
  • Fax: 619-260-7038
Mailing address:
  • Phone: 619-260-7021
  • Fax: 619-260-7038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberF320073
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPF18168
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: