=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972131761
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES TOLENTINO PA-C, CAQ-PSYCH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2020
-----------------------------------------------------
Last Update Date | 12/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1760 TERMINO AVE STE G21
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90804-2182
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-545-5550
-----------------------------------------------------
Fax | 949-298-5928
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19782 MACARTHUR BLVD STE 300
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92612-2417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-545-5550
-----------------------------------------------------
Fax | 949-991-2040
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA58801
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 364SP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
-----------------------------------------------------
License Number | PA58801
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------