Healthcare Provider Details

I. General information

NPI: 1023497641
Provider Name (Legal Business Name): ADRIANO TINEBRA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 FAIRVIEW AVE
CINCINNATI OH
45219-1159
US

IV. Provider business mailing address

135 MERCHANT ST
CINCINNATI OH
45246-3735
US

V. Phone/Fax

Practice location:
  • Phone: 513-207-6472
  • Fax:
Mailing address:
  • Phone: 513-252-0248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number1500185
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: