Organization
DERRICK TINT MD, CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DERRICK TINT MD (OWNER)
(949) 246-3072
Entity
Organization
Contact information
Practice address
341 MAGNOLIA AVE STE 206, CORONA, CA 92879-3332
(951) 735-0470
Mailing address
341 MAGNOLIA AVE STE 206, CORONA, CA 92879-3332
(951) 735-0470
(951) 735-2706
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1033554423
INDIVIDUAL NPI
—
01
—
A160407
MEDICAL LICENSE
CA
01
—
MD463754
MEDICAL LICENSE
PA
Enumeration date
01/06/2021
Last updated
03/07/2023
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