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NPI Code Detail

MEDICARE: TINA VITHAL

MEDICARE: TINA VITHAL
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1649053190
Entity Type Code : Individual
Provider Name (Legal Business Name) : TINA VITHAL
Provider Business Mailing Address
First Line : 309 E 2ND ST
Second Line :
City : POMONA
State : CA
Zip : 91766-1854
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 309 E 2ND ST
Second Line :
City : POMONA
State : CA
Zip : 91766-1854
Country : US
Telephone Number : --
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2023
Last Update Date : 01/13/2026

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Directions to “ TINA VITHAL ” Practice Location

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