Healthcare Provider Details

I. General information

NPI: 1861835944
Provider Name (Legal Business Name): MARIANE TOLENTINO IDMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 06/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 E DEER SPRINGS WAY APT 3118
NORTH LAS VEGAS NV
89086-1407
US

IV. Provider business mailing address

2655 E DEER SPRINGS WAY APT 3118
NORTH LAS VEGAS NV
89086-1407
US

V. Phone/Fax

Practice location:
  • Phone: 702-653-2344
  • Fax:
Mailing address:
  • Phone: 702-653-2344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: