Healthcare Provider Details

I. General information

NPI: 1780512632
Provider Name (Legal Business Name): MR. SAMUEL TOLEDANO SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20827 N CAVE CREEK RD STE 106
PHOENIX AZ
85024-4471
US

IV. Provider business mailing address

20827 N CAVE CREEK RD STE 106
PHOENIX AZ
85024-4471
US

V. Phone/Fax

Practice location:
  • Phone: 602-471-7007
  • Fax:
Mailing address:
  • Phone: 602-471-7007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number21244-2751
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: