Basic Information
| Provider Information | |||||||||
| NPI: | 1487250759 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOLENTINO | ||||||||
| FirstName: | MARIA CRYSTALLINE | ||||||||
| MiddleName: | DIONISIO | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 N 23RD ST | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785016127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566874560 | ||||||||
| FaxNumber: | 9566181342 | ||||||||
| Practice Location | |||||||||
| Address1: | 720 E. EDINBURG AVE. | ||||||||
| Address2: | SUITE 1009 | ||||||||
| City: | ELSA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9562629131 | ||||||||
| FaxNumber: | 9562629232 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2020 | ||||||||
| LastUpdateDate: | 12/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1340848 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1340848 | 01 | IL | LICENSE | OTHER |