Provider Demographics
NPI:1093975237
Name:CRUZ-TOLENTINO, MINNIE SHEILA L (MD)
Entity type:Individual
Prefix:
First Name:MINNIE SHEILA
Middle Name:L
Last Name:CRUZ-TOLENTINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 VILLAGE MARKET BLVD SE STE 119
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-4730
Mailing Address - Country:US
Mailing Address - Phone:703-777-9355
Mailing Address - Fax:703-783-5395
Practice Address - Street 1:1604 VILLAGE MARKET BLVD SE STE 119
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-4730
Practice Address - Country:US
Practice Address - Phone:703-777-9355
Practice Address - Fax:703-783-5395
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101260506207Q00000X
ME018877207Q00000X
NY272568207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine