Provider Demographics
NPI:1124057930
Name:MOLUMPHY, TINA (MD)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:MOLUMPHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:851 FREMONT AVE.
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5620
Mailing Address - Country:US
Mailing Address - Phone:650-941-1040
Mailing Address - Fax:650-941-1001
Practice Address - Street 1:340 DARDANELLI LN STE 10
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1418
Practice Address - Country:US
Practice Address - Phone:408-412-8100
Practice Address - Fax:408-412-8499
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA609232081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH01927Medicare UPIN