Provider Demographics
NPI:1861867715
Name:TINOCO, MARIA MONTESSA (NP-C)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:MONTESSA
Last Name:TINOCO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4477 W 118TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2255
Mailing Address - Country:US
Mailing Address - Phone:310-675-4440
Mailing Address - Fax:310-675-2970
Practice Address - Street 1:4477 W 118TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2255
Practice Address - Country:US
Practice Address - Phone:310-675-4440
Practice Address - Fax:310-675-2970
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95003429363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner