Provider Demographics
NPI:1144846270
Name:TINOCO, CRISTINA NEFTALI
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:NEFTALI
Last Name:TINOCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12391 SAGE GROUSE LN
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-2048
Mailing Address - Country:US
Mailing Address - Phone:951-446-9996
Mailing Address - Fax:
Practice Address - Street 1:12391 SAGE GROUSE LN
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-2048
Practice Address - Country:US
Practice Address - Phone:951-446-9996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA706898164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse