Individual provider Active NPI

Justin Tolentino, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Upland, CA
National Provider Identifier
1144815754
Registry record updated Oct 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95035349 Issued in CA
Practice address
1113 Alta Ave Ste 106
Upland, CA 91786-2803
Phone
(909) 638-2475
NPI assigned
Mar 5, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Registered Nurse 163WP0808X 95116951 CA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95035349 CA Primary

Addresses

Primary practice location

1113 Alta Ave Ste 106
Upland, CA 91786-2803

Mailing address

1113 Alta Ave Ste 106
Upland, CA 91786-2803
Phone (909) 851-4029

Other practice location 1

5330 San Bernardino St
Montclair, CA 91763-2952
Phone (866) 205-3595

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260210001362 CA Practitioner - Nurse Practitioner 6800375874 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1113 Alta Ave
Suite 106
Upland, CA 91786-2800

1812 Verdugo Blvd
Glendale, CA 91208-1407

File Number
Suite 54701
Los Angeles, CA 90074-4701

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95116951CAMDPsychiatric/Mental Health Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Sameer Sunita Hassamal & Company, Apc CurrentSince Jan 27, 2026 Accepting new patients

Locations

2409 N Sepulveda Blvd
Ste 205
Manhattan Beach, CA 90266
Phone (909) 353-2947

1113 Alta Ave
Ste 106
Upland, CA 91786
Phone (909) 353-2947

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761523200000",
    "number": "1144815754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1113 ALTA AVE STE 106",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917862803",
            "telephone_number": "909-851-4029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1113 ALTA AVE STE 106",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917862803",
            "telephone_number": "909-638-2475"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5330 San Bernardino St",
            "address_purpose": "LOCATION",
            "city": "Montclair",
            "state": "CA",
            "postal_code": "917632952",
            "country_code": "US",
            "telephone_number": "866-205-3595",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TOLENTINO",
        "first_name": "JUSTIN",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-05",
        "last_updated": "2025-10-27",
        "certification_date": "2025-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95116951",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95035349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Upland, CA

Sources for this page

Verify at the official NPI Registry.