Provider Demographics
NPI:1194725358
Name:TOLENTINO, JEANETTE GALICINAO (MD)
Entity type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:GALICINAO
Last Name:TOLENTINO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:
Other - Last Name:GALICINAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3087 E WARM SPRINGS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3754
Mailing Address - Country:US
Mailing Address - Phone:702-463-1011
Mailing Address - Fax:702-463-1219
Practice Address - Street 1:3087 E WARM SPRINGS RD STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3754
Practice Address - Country:US
Practice Address - Phone:702-463-1011
Practice Address - Fax:702-463-1219
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11843208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNI00707Medicare UPIN
TN3891470Medicare ID - Type Unspecified