MEDICARE: MS. TONI SHERLITA COLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LC50078380	DC

General Provider Information

NPI Number	:	1942475496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TONI SHERLITA COLE

Provider Business Mailing Address
First Line	:	7410 MISSION VALLEY RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-4405
Country	:	US
Telephone Number	:	619-400-5157
Fax Number	:	619-400-5159

Provider Business Practice Location Address
First Line	:	7410 MISSION VALLEY RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-4405
Country	:	US
Telephone Number	:	619-400-5157
Fax Number	:	619-400-5159

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2008
Last Update Date	:	04/09/2015

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