Provider Demographics
NPI:1144815754
Name:TOLENTINO, JUSTIN (PMHNP)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:TOLENTINO
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 ALTA AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-2803
Mailing Address - Country:US
Mailing Address - Phone:909-851-4029
Mailing Address - Fax:
Practice Address - Street 1:1113 ALTA AVE STE 106
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-2803
Practice Address - Country:US
Practice Address - Phone:909-638-2475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95116951163WP0808X
CA95035349363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health