MEDICARE: MR. PATRICK MARCELINO TINEO RUIZ CMA, PTC

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	246RP1900X	Phlebotomy Technician
2	172V00000X	Community Health Worker	CHW11512	MA
3	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1669263935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK MARCELINO TINEO RUIZ CMA, PTC

Provider Business Mailing Address
First Line	:	10 LORING ST APT 1
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01606-3575
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 LORING ST APT 1
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01606-3575
Country	:	US
Telephone Number	:	646-322-6349
Fax Number	:

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

Provider Enumeration Date	:	05/15/2025
Last Update Date	:	02/05/2026

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