Active NPI
Tinna Budiantoro, LVN
- Licensed Vocational Nurse
- Corona, CA
National Provider Identifier
1679403901
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Vocational Nurse
- License
- 709622
- Practice address
- 1186 Border Ave Apt C
Corona, CA 92882-3055 - Phone
- (512) 981-3364
- NPI assigned
- May 20, 2026
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Vocational Nurse | 164X00000X | 709622 | CA | Primary |
Addresses
Primary practice location
1186 Border Ave Apt C
Corona, CA 92882-3055
Mailing address
1186 Border Ave Apt C
Corona, CA 92882-3055
Phone (512) 981-3364
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 709622 | CA | MD | Licensed Vocational Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1779235200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1779235200000",
"number": "1679403901",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1186 BORDER AVE APT C",
"city": "CORONA",
"state": "CA",
"postal_code": "928823055",
"telephone_number": "512-981-3364"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1186 BORDER AVE APT C",
"city": "CORONA",
"state": "CA",
"postal_code": "928823055",
"telephone_number": "512-981-3364"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUDIANTORO",
"first_name": "TINNA",
"credential": "LVN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2026-05-20",
"last_updated": "2026-05-20",
"certification_date": "2026-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "164X00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Licensed Vocational Nurse",
"state": "CA",
"license": "709622",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.