Provider Demographics
NPI:1447868146
Name:PATUBO, MAILA TOLENTINO (RN)
Entity type:Individual
Prefix:
First Name:MAILA
Middle Name:TOLENTINO
Last Name:PATUBO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MAILA
Other - Middle Name:GARASI
Other - Last Name:TOLENTINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:84358 SCARLET WAY
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-7337
Mailing Address - Country:US
Mailing Address - Phone:760-771-7032
Mailing Address - Fax:
Practice Address - Street 1:47915 OASIS ST
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-6950
Practice Address - Country:US
Practice Address - Phone:760-863-8638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA646549163W00000X, 163WM0705X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical