MEDICARE: REYNALDO T TOLENTINO MD PLLC

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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1386041846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REYNALDO T TOLENTINO MD PLLC

Provider Business Mailing Address
First Line	:	4301 COLLEGE DR
Second Line	:	RM 500
City	:	VERNON
State	:	TX
Zip	:	76384-3128
Country	:	US
Telephone Number	:	940-552-6800
Fax Number	:	940-552-6802

Provider Business Practice Location Address
First Line	:	4301 COLLEGE DR
Second Line	:	RM 500
City	:	VERNON
State	:	TX
Zip	:	76384-3128
Country	:	US
Telephone Number	:	940-552-6800
Fax Number	:	940-552-6802

Authorized Official
Title or Position	:	SOLE OWNER/MEMBER
Name	:	REYNALDO T TOLENTINO
Credential	:	MD
Telephone Number	:	940-552-6800

Provider Enumeration Date	:	11/29/2014
Last Update Date	:	11/29/2014

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