Provider Demographics
NPI:1609201417
Name:TOLENTINO, JACLYN JEAN (DO)
Entity type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:JEAN
Last Name:TOLENTINO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 FOWLING ST
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-7729
Mailing Address - Country:US
Mailing Address - Phone:305-458-7824
Mailing Address - Fax:
Practice Address - Street 1:740 S PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4717
Practice Address - Country:US
Practice Address - Phone:310-563-7366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A16308207Q00000X
FLOS12358207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine