Healthcare Provider Details

I. General information

NPI: 1447214721
Provider Name (Legal Business Name): FELIPE I TOLENTINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 WASHINGTON ST # 450
BOSTON MA
02111-1526
US

IV. Provider business mailing address

9 HAWTHORNE PL 16 E
BOSTON MA
02114-2344
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-7951
  • Fax: 617-636-4866
Mailing address:
  • Phone: 617-367-8075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number33808
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: