# DERRICK TINT MD, CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659969590
- **Authorized official:** DR. DERRICK TINT MD (OWNER)
- **Authorized official phone:** (949) 246-3072

## Contact information

- **Practice address:** 341 MAGNOLIA AVE STE 206, CORONA, CA 92879-3332
- **Practice address phone:** (951) 735-0470
- **Mailing address:** 341 MAGNOLIA AVE STE 206, CORONA, CA 92879-3332
- **Mailing address phone:** (951) 735-0470
- **Mailing address fax:** (951) 735-2706

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 01/06/2021
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1033554423 | INDIVIDUAL NPI | — |
| 01 | — | A160407 | MEDICAL LICENSE | CA |
| 01 | — | MD463754 | MEDICAL LICENSE | PA |