Healthcare Provider Details

I. General information

NPI: 1194725358
Provider Name (Legal Business Name): JEANETTE GALICINAO TOLENTINO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEANETTE GALICINAO MD

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3087 E WARM SPRINGS RD STE 200
LAS VEGAS NV
89120-3754
US

IV. Provider business mailing address

3087 E WARM SPRINGS RD STE 200
LAS VEGAS NV
89120-3754
US

V. Phone/Fax

Practice location:
  • Phone: 702-463-1011
  • Fax: 702-463-1219
Mailing address:
  • Phone: 702-463-1011
  • Fax: 702-463-1219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11843
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: