Provider Demographics
NPI:1336751072
Name:TOLENTINO PETTIGREW, RORY (PSYD)
Entity type:Individual
Prefix:DR
First Name:RORY
Middle Name:
Last Name:TOLENTINO PETTIGREW
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:RORY
Other - Middle Name:
Other - Last Name:TOLENTINO PETTIGREW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:700 EL CAMINO REAL STE 120
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4884
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 S ELLSWORTH AVE STE 802
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3926
Practice Address - Country:US
Practice Address - Phone:650-822-1057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-22
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY35642103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical