Provider Demographics
NPI:1144514498
Name:GOLDIANO, TINA (RDHAP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:GOLDIANO
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:GOLDIANO-SUBAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDHAP
Mailing Address - Street 1:411 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-5716
Mailing Address - Country:US
Mailing Address - Phone:415-473-5450
Mailing Address - Fax:415-473-5460
Practice Address - Street 1:411 4TH ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-5716
Practice Address - Country:US
Practice Address - Phone:415-473-5450
Practice Address - Fax:415-473-5460
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH 15634124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist