Basic Information
| Provider Information | |||||||||
| NPI: | 1750699658 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TINO | ||||||||
| FirstName: | FELICITA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1854 W AVENUE J12 | ||||||||
| Address2: | P201 | ||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935344644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6616192574 | ||||||||
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| Practice Location | |||||||||
| Address1: | 40005 10TH ST W | ||||||||
| Address2: | STE 106 | ||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935513037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612658627 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2010 | ||||||||
| LastUpdateDate: | 02/05/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 28263 | CA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.