1477590792 NPI number — LUIS R. ROSA TOLEDO M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477590792 NPI number — LUIS R. ROSA TOLEDO M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

ROSA TOLEDO

Provider First Name:

LUIS

Provider Middle Name:

R.

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1477590792

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

08/03/2010

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

HC 4 BOX 30335

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

HATILLO

Provider Business Mailing Address State Name:

PR

Provider Business Mailing Address Postal Code:

00659-9408

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

787-854-4122

Provider Business Mailing Address Fax Number:

787-854-3270

Provider First Line Business Practice Location Address:

B43 CALLE ELLIOT VELEZ

Provider Second Line Business Practice Location Address:

URB. ATENAS

Provider Business Practice Location Address City Name:

MANATI

Provider Business Practice Location Address State Name:

PR

Provider Business Practice Location Address Postal Code:

00674-4615

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

787-854-4122

Provider Business Practice Location Address Fax Number:

787-854-3270

Provider Enumeration Date:

06/02/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  11488 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1297 . This is a "PMC MEDICARE CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: N221 . This is a "INTERNATIONAL MEDICAL CAR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: PE2903 . This is a "PALIC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 065970 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 3603105 . This is a "ACCA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 8-4426 . This is a "SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 995224 . This is a "MMM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 2-11488 . This is a "CIGNA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 6740012 . This is a "HUMANA HEALTH PLANS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 990183 . This is a "HEALTH PLUS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".