Healthcare Provider Details

I. General information

NPI: 1497026496
Provider Name (Legal Business Name): ELVIRA P TOLENTINO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2012
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5274 GOLDEN GATE PARKWAY SUITE 1
NAPLES FL
34116-2154
US

IV. Provider business mailing address

5274 GOLDEN GATE PARKWAY SUITE 1
NAPLES FL
34116-3510
US

V. Phone/Fax

Practice location:
  • Phone: 239-455-9919
  • Fax: 239-455-9909
Mailing address:
  • Phone: 239-455-9919
  • Fax: 973-904-9274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA04671100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number25MA04671100
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25MA04671100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: