Basic Information
| Provider Information | |||||||||
| NPI: | 1447264023 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOLENTINO | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3315 WATT AVE | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958213600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164816800 | ||||||||
| FaxNumber: | 9164811881 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 B GALE WILSON BLVD | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945333552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7076465000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 05/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 0101238378 | VA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 0101238378 | VA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | C140968 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 139230 | 01 | VA | ANTHEM | OTHER | 1447264023 | 05 | VA | MEDICAID | 297577 | 01 | VA | AMERIGROUP | OTHER | 484645 | 01 | VA | NCPPO | OTHER | K142-0001 | 01 | DC | CAREFIRST | OTHER | CA311940 | 05 | CA | MEDICAID | P00308248 | 01 | VA | RAILROAD MEDICARE | OTHER | 9405007 | 01 | VA | PHCS | OTHER |