MEDICARE: ANITA SAMANEGO TOLENTINO-MACARAEG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	A52490	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000000	OTHER	CA	NONE PROVIDER NUMBEER

General Provider Information

NPI Number	:	1194828996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANITA SAMANEGO TOLENTINO-MACARAEG M.D.

Provider Business Mailing Address
First Line	:	591 MCCRAY ST STE 231
Second Line	:
City	:	HOLLISTER
State	:	CA
Zip	:	95023-2224
Country	:	US
Telephone Number	:	831-636-3116
Fax Number	:

Provider Business Practice Location Address
First Line	:	591 MCCRAY ST STE 231
Second Line	:
City	:	HOLLISTER
State	:	CA
Zip	:	95023-2224
Country	:	US
Telephone Number	:	831-636-3116
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	02/11/2025

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