Provider Demographics
NPI:1063621209
Name:TOLENTINO, JONATHAN L (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:L
Last Name:TOLENTINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 NW 14TH ST # ST960
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-2107
Mailing Address - Country:US
Mailing Address - Phone:305-243-4258
Mailing Address - Fax:305-243-7096
Practice Address - Street 1:1150 NW 14TH ST STE 411
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-2137
Practice Address - Country:US
Practice Address - Phone:305-243-4900
Practice Address - Fax:305-243-4966
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME143438208000000X, 207R00000X, 207R00000X
OH35.092088208000000X
FL143438208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3039278Medicaid
IN200988420Medicaid
KY7100112680Medicaid
OH4291182Medicare PIN
OH3039278Medicaid