Individual
RONALDO CHINO PETALLO TANEDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3930 4TH AVE STE 300, SAN DIEGO, CA 92103-3119
(619) 320-8711
(619) 393-0818
Mailing address
3930 4TH AVE STE 300, SAN DIEGO, CA 92103-3119
(619) 320-8711
(619) 393-0818
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
739150
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95032892
CA
Other
Enumeration date
01/29/2018
Last updated
01/21/2025
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