Healthcare Provider Details

I. General information

NPI: 1316127004
Provider Name (Legal Business Name): DAPHNE ANN TOLENTINO AA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW
WASHINGTON DC
20010-3017
US

IV. Provider business mailing address

11510 GEORGIA AVE SUITE 206
WHEATON MD
20902-1925
US

V. Phone/Fax

Practice location:
  • Phone: 301-946-5100
  • Fax: 301-929-0348
Mailing address:
  • Phone: 301-946-5100
  • Fax: 301-929-0348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA000012
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: